STEVENSON & ASSOCIATES, INC.

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ProScanT Survey Card (400 Series)

DIRECTIONS: Mark the response which best describes HOW YOU FEEL YOU REALLY ARE on a scale from 1 to 5, with 1 being NO OR LEAST and 5 being YES OR MOST.

No......................................Yes

1 Trustworthy 1 2 3 4 5

2 Gentle 1 2 3 4 5

3 Spirited 1 2 3 4 5

4 Understanding 1 2 3 4 5

5 Individualistic 1 2 3 4 5

6 Esteemed 1 2 3 4 5

7 Earnest 1 2 3 4 5

8 Compassionate 1 2 3 4 5

9 Convincing 1 2 3 4 5

10 Bold 1 2 3 4 5

11 Precise 1 2 3 4 5

12 Adaptable 1 2 3 4 5

13 Organized 1 2 3 4 5

14 Aggressive 1 2 3 4 5

15 Shy 1 2 3 4 5

16 Compelling 1 2 3 4 5

17 Calm 1 2 3 4 5

18 Daring 1 2 3 4 5

19 Spontaneous 1 2 3 4 5

20 Outgoing 1 2 3 4 5

21 Fussy 1 2 3 4 5

22 Talkative 1 2 3 4 5

23 Demanding 1 2 3 4 5

24 Industrious 1 2 3 4 5

25 Generous 1 2 3 4 5

26 Careful 1 2 3 4 5

27 Pleasant 1 2 3 4 5

28 Conventional 1 2 3 4 5

29 Warm 1 2 3 4 5

30 Efficient 1 2 3 4 5

Note NEW
DIRECTIONS: Mark the response which best describes HOW YOU FEEL OTHERS EXPECT YOU TO BE OR ACT on a scale from 1 to 5, with 1 being NO OR LEAST and 5 being YES OR MOST.

Personal Information:

First Name: Last Name:

Company Name: Dept.

Title/Position:

Address: Suite:

City: State:

Zip Code: Phone:

Manager:

Email Address:

How did you hear about us?

If referred by a customer or representative,
please tell us their name.

Which challenges are concerns?

(You may make more than one selection, Ctrl + click.)

Comments: