CogWell Listen Up Pre-Survey
Thank you for signing up for one of our training sessions! We hope you'll have fun attending and learn the important skills of Active Listening. We'd like to see where everyone is coming from so we can better serve the your school community, so please take a moment to fill out this pre-survey!

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Full Name *
School Email *
Type of Presentation Venue *
Please indicate your gender.
 *
Please indicate your religious affiliation. 
 *
Please indicate your race. 
 *
Please indicate your ethnicity. 
 *
Are you a 1st generation college student?
 *
Type of Presentation *
School *
What is the name of the group you are specifically associated with for this training? (ex. frat, student club, sports team, etc.) *
Which of following best describes your group? *
Which one best describes your current status? *
What major or field of study are you currently studying? *
How comfortable are you with talking with your classmates about any issues they're facing? *
Not Very
Very Much
How comfortable are you talking about mental health with your friends?   *
Not Very
Very Much
How comfortable are you seeking help and support from the counseling center? *
Not Very
Very Much
How often do your friends talk with you about the challenges they’re facing? *
When talking with your friends, how confident are you about being a good listener? *
Not Very
Very Much
Based on past experiences, how much do you agree with the following statements? *
Disagree
Slightly Disagree
Slightly Agree
Agree
I’m aware of my own feelings while I’m listening to others
When I talk to others, I pay attention to their unexpressed feelings
When I talk to people, I try to put myself in their shoes
If I have something to say, I talk about it, even if I interrupt someone else
Based on past experiences, how much do you agree with the following statements?
 *
Disagree
Slightly Disagree
Slightly Agree
Agree
I don’t talk with someone else unless I have something I have to talk about.
While listening, I get annoyed from not understanding the other person’s feelings.
I listen to him/her absent-mindedly.
I express my feelings straightforwardly.
I can listen to other persons’ worries, but I can’t share my own.
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