Survey | Qualtrics Survey Software

Name of Applicant

Current Status

College Address

Permanent Address

Current Major

Number of accumulated semester hours

Cumulative GPA

State reasons for transferring from current major

Provide some background information relative to your interest in Urban Education (volunteer work, community service, etc.)

Please rate yourself based on the items below. Indicate the response that is the most appropriate in describing your Intrapersonal skills.

Please rate yourself based on the items below. Indicate the response that is the most appropriate in describing your Intrapersonal skills.
			Always	Sometimes	Never
I am able to express my ideas to others
I can easily understand and express the way I feel.
I am more of a leader than a follower.

Please rate yourself based on the items below. Indicate the response that is the most appropriate in describing your Interpersonal skills.

Please rate yourself based on the items below. Indicate the response that is the most appropriate in describing your Interpersonal skills.
			Always	Sometimes	Never
I like helping people
I am good at understanding the way other people feel.
I have good relations with others.

Please rate yourself based on the items below. Indicate the response that is the most appropriate in describing your stress management skills.

Please rate yourself based on the items below. Indicate the response that is the most appropriate in describing your stress management skills.
			Always	Sometimes	Never
I am sometimes impulsive.
I feel it is sometimes hard for me to control my anxiety.
I am impatient.

Please rate yourself based on the items below. Indicate the response that is the most appropriate in describing your ability to adapt.

Please rate yourself based on the items below. Indicate the response that is the most appropriate in describing your ability to adapt.
			Always	Sometimes	Never
I take a step by step approach to overcome difficulties.
I like to get an overview of the problem before attempting to solve it.
When trying to solve a problem, I look at each possibility and then decide on teh best way.

Please rate yourself based on the items below. Indicate the response that is the most appropriate in describing your general mood.

Please rate yourself based on the items below. Indicate the response that is the most appropriate in describing your general mood.
			Always	Sometimes	Never
I am a fairly cheerful person.
I am satisfied with my life.
I generally expect things will turn out all right, despite occasional setbacks.

Rate your ability to communicate information.

Rate your ability to communicate information.
			Excellent	Good	Developing	I struggle quite a bit
verbally
in writing

Discuss your interest in Urban Education