Cognizance, Perception and prevalence of self-harm among undergraduates in the United States.
Dear Participant,
I, Jonathan Wilcox, am an aspiring Master of science in the discipline of Psychology at an American University. I am carrying out a research on the cognizance, perception and prevalence of self-harm among undergraduates in the United States. This is in partial fulfillment of the requisite of the award of Masters in my field.
I humbly appeal to you to treat this questionnaire veraciously and honestly and assure you that any information here will be treated confidentially and utilized for research purposes only.
Your name, and every other personally identifying info is not required, but optional.
* Required
Age
Your answer
Sex
*
Female
Male
Prefer not to say
Other:
Highest level of education
*
Your answer
Occupational Status
*
Unemployed
Student
Veteran
Employed
Self Employed
Other:
Relationship Status
*
SIngle
Married
Engaged
Separated/Divorced
Choose not to specify
Other:
Religion
*
Christianity
Islam
Atheist
Free thinker
I choose not to answer
Have you heard about self harm?
Yes
No
Maybe
Do you have any friend or relative who commited suicide?
Yes
No
Maybe
Self harm is about staying in control
Yes
No
Maybe
Self harm is a form of communication
Yes
No
Maybe
Self harm is associated with release of Anger.
Yes
No
Maybe
Self harm is more prevalent in poor people.
Yes
No
Maybe
Self harm is a precursor to suicide
Yes
No
Maybe
Self harm is fatal and can lead to destruction of the body.
Yes
No
Maybe
Self harm does not affect men and women equally.
Yes
No
Maybe
Complete captcha to send
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service
-
Privacy Policy
Forms
