SURPS Questionnaire – Aspire Social Enterprise

Home
Speak to Us: 1300 722 680

Home
Speak to Us: 1300 722 680

Preventure SURPS Questionnaire

Before completing this questionnaire below, please take a minute to watch the following video to ensure the correct outcomes.

Name (First Name and Surname Initial Only - i.e. John S) *

School / Organisation Name *

Year Level / Form

1. I am content or satisfied (pleased with life in general). *

1 - Strongly Disagree
2 - Disagree
3 - Agree
4 - Strongly Agree

2. I often don’t think things through before I speak. *

1 - Strongly Disagree
2 - Disagree
3 - Agree
4 - Strongly Agree

3. I would like to skydive (parachute out of a plane). *

1 - Strongly Disagree
2 - Disagree
3 - Agree
4 - Strongly Agree

4. I am happy. *

1 - Strongly Disagree
2 - Disagree
3 - Agree
4 - Strongly Agree

5. I often involve myself in situations that I later regret being involved in. *

1 - Strongly Disagree
2 - Disagree
3 - Agree
4 - Strongly Agree

6. I enjoy new and exciting experiences even if they are unconventional (out of the ordinary). *

1 - Strongly Disagree
2 - Disagree
3 - Agree
4 - Strongly Agree

7. I have faith that my future holds great promise. *

1 - Strongly Disagree
2 - Disagree
3 - Agree
4 - Strongly Agree

8. It’s frightening to feel dizzy or faint. *

1 - Strongly Disagree
2 - Disagree
3 - Agree
4 - Strongly Agree

9. I like doing things that frighten me a little. *

1 - Strongly Disagree
2 - Disagree
3 - Agree
4 - Strongly Agree

10. It frightens me when I feel my heart beat change. *

1 - Strongly Disagree
2 - Disagree
3 - Agree
4 - Strongly Agree

11. I usually act without stopping to think. *

1 - Strongly Disagree
2 - Disagree
3 - Agree
4 - Strongly Agree

12. I would like to learn how to drive a motorcycle. *

1 - Strongly Disagree
2 - Disagree
3 - Agree
4 - Strongly Agree

13. I feel proud of my accomplishments (achievements). *

1 - Strongly Disagree
2 - Disagree
3 - Agree
4 - Strongly Agree

14. I get scared when I’m too nervous. *

1 - Strongly Disagree
2 - Disagree
3 - Agree
4 - Strongly Agree

15. Generally, I am an impulsive person (a person who does things “on the spur of the moment”, without thinking of what the consequences (outcome/result) will be). *

1 - Strongly Disagree
2 - Disagree
3 - Agree
4 - Strongly Agree

16. I am interested in experience for its own sake, even if it is illegal. *

1 - Strongly Disagree
2 - Disagree
3 - Agree
4 - Strongly Agree

17. I feel that I’m a failure. *

1 - Strongly Disagree
2 - Disagree
3 - Agree
4 - Strongly Agree

18. I get scared when I experience unusual body sensations (feelings). *

1 - Strongly Disagree
2 - Disagree
3 - Agree
4 - Strongly Agree

19. I would enjoy hiking (walking) long distances in wild and uninhabited territory. *

1 - Strongly Disagree
2 - Disagree
3 - Agree
4 - Strongly Agree

20. I feel pleasant. *

1 - Strongly Disagree
2 - Disagree
3 - Agree
4 - Strongly Agree

21. It scares me when I’m unable to focus on a task. *

1 - Strongly Disagree
2 - Disagree
3 - Agree
4 - Strongly Agree

22. I feel I have to be crafty or manipulative (sneaky) to get what I want. *

1 - Strongly Disagree
2 - Disagree
3 - Agree
4 - Strongly Agree

23. I am very enthusiastic (positive/excited) about my future. *

1 - Strongly Disagree
2 - Disagree
3 - Agree
4 - Strongly Agree

Support Us With a Tax Deductable Donation

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Insert your Donation Amount (Note: AU$)

Alternatively, you can choose to Sponsor an Intiative (AU$)

SchoolFit Sponsorship - $ 5,000.00
Preventure Sponsorship - $ 3,500.00
Pay it Forward - Individual Counselling Session - $ 95.00

Square *

Card

Name on Card

Total Amount

$ 0.00

If you would like to leave a comment with your donation, we love feedback and support!

166 Morayfield Road, Morayfield QLD 4510

Scroll to Top