Cavity Search Questionnaire
Cavity Search Questionnaire
Responses to the following questions will remain confidential.
Name:
Age:
Highest Level of Education:
Major or Primary Focus at School:
What do you do for work:
Do you feel fulfilled at your job (please explain):
What is your dream job:
Why don’t you have this job:
Parents’ names:
Please describe your relationship with each (give at least 1 positive and 1 negative):
Do you have any siblings:
Please give names of each sibling and describe your relationship (give at least 1 positive and 1 negative):
Where did you think you’d be 5 years ago:
What are you most proud of achieving:
What are your biggest regrets:
What are some words you know exist about the following (socially acceptable and derogatory):
Jewish people:
Do you know any Jewish people?
Black people:
Do you know any Black people?
Asians people:
Do you know any Asian people?
Disabled people:
Do you know any disabled people?
Homosexuals:
Do you know any homosexual people (closeted or out)?
Have you ever had a homosexual experience and please say what it was (crush, kissing, sex, etc)?
What are you most afraid of?
Tell me one secret you haven’t told anyone else.
Give an instance where you remained silent and did not act on what you felt was a moral obligation:
Give an instance where you stood up for what you felt was a moral obligation:
Where would you like to be in 10 years:
