Storytelling Pre-Survey v5
This survey will collect information in order to assess the impact of the storytelling process on belonging. Please answer each question as objectively as possible with regard to your current (not ideal or hoped for) experience of belonging. Belonging is comprised of identity (your unique role in your community), value (of that role to your community), and need (what you need from your community to thrive in your identity). These elements of belonging are experienced in the context of healthy, interdependent relationships and individually expressed in a shared narrative.
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1. Please create a five digit code using the first letter of your first name and the last four digits of your phone number. Remember this code and use it again on the post-survey you will take at the completion of the study. Thank you
2. The following questions refer to members of what community?
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3. What is your gender?
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4. What is your sexual orientation?
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What is your age?
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Are you now:
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What is the highest level of school you have completed or the highest degree you have received?
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Please select the category that best describes your race.
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Please select one of the following categories that best describes your ethnicity.
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Which of the following best describes your employment status?
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Which of the following best describes your neighborhood?
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Which of the following best describes your income?
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Would you consider yourself marginalized for any of the following reasons?
How would you rate your level of marginalization?
Very Marginalized
Not Marginalized at all
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How often have you participated in storytelling processes before now?
Never
Very often
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How would you rate your feeling of belonging overall? *
I don't feel belonging
Very content
Do you experience belonging with any other groups or organizations?
No Belonging
High Belonging
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On average, how well do you know the other members of this group?
Not very well
Very well
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On average, how well do the other members of this group know you?
Not very well
Very well
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Do you have a clearly established identity in this group?
No role
Clearly established role
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Do you feel valued by the other members of this group?
Not valued
Very valued
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How well does this group meet your social and emotional needs?
Not very well
Very well
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Do you have a nickname in this group?
No nickname
Well established nickname
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If you answered yes to the question about nickname and feel comfortable sharing, what is your nickname in this group?
How would you rate your feeling of belonging with this group? *
I don't feel belonging
Very content
How would you rate your feeling of belonging in your micro-systems (family, school, friend group, work group, sports team, etc.)?
I don't feel belonging
Very content
Clear selection
How would you rate your feeling of belonging in the organizations you are connected to (neighborhood association, church, work, volunteer organization, local government, coalitions, etc.)?
I don't feel belonging
Very content
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How would you rate your feeling of belonging in your geographic location (neighborhood, town, community, etc.)?
I don't feel belonging
Very content
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Please describe your positive or negative feelings about participating in a storytelling process in this group.
How much do you agree with the following statements? *
Not at all
Somewhat
Mostly
Completely
1. When I am with other people, I feel included
2. I have close bonds with family and friends
3. I feel like an outsider
4. I feel as if people do not care about me
5. I feel accepted by others
6. Because I do not belong, I feel distant during the holiday season
7. I feel isolated from the rest of the world
8. I have a sense of belonging
9. When I am with other people, I feel like a stranger
10. I have a place at the table with others
11. I feel connected with others
12. Friends and family do not involve me in their plans
How important is it to you to feel a sense of community with other community members?
How well do each of the following statements represent how you feel about this community? *
Not at all
Somewhat
Mostly
Completely
1. I get important needs of mine met because I am part of this community
2. Community members and I value the same things
3. This community has been successful in getting the needs of its members met
4. Being a member of this community makes me feel good
5. When I have a problem, I can talk about it with other members of this community
6. People in this community have similar needs, priorities, and goals
7. I can trust people in this community
8. I can recognize most of the people in this community
9. Most community members know me
10. This community has symbols and expressions of membership such as clothes, signs, art, architecture, logos, landmarks, and flags that people can recognize
11. I put a lot of time and effort into being part of this community
12. Being a member of this community is part of my identity
13. Fitting into this community is part of my identiy
14. This community can influence other communities
15. I care about what other community members think of me
16. I have influence over what this community is like
17. If there is a problem in this community, members can get it solved
18. This community has good leaders
19. It is very important to me to be part of this community
20. I am with other community members a lot and enjoy being with them
21. I expect to be a part of this community for a long time
22. Members of this community have shared important events together, such as holidays, celebrations, or disasters
23. I feel hopeful about the future of this community
24. Members of this community care about each other
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