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Survey Name

Survey Name


1.
Under 30
31-40
41-50
51-60
61-70
70+
What is your age?
2.
Male
Female
Gender:
3.
Married
Divorced/Widowed
Single
Marital Status:
Highest Degree Received:
5.
Extremely Satisfied
Moderately Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Moderately Dissatisfied
Extremely Dissatisfied
How satisfied are you with the graduate training that you received?
Licensure: Please check all that apply:
Years of post-graduate experience:
Current Practice Setting:
9.
Less than $15,000
$15,000-$20,000
$21,000-$30,000
$31,000-$40,000
$41,000-$50,000
$60,000+
Annual income:
Professional Self-View:
Primary Theoretical Orientation:
What is your secondary theoretical approach used most often?
13.
Extremely Satisfied
Moderately Satisfied
Somewhat Satisfied:
Somewhat Dissatisfied
Moderately Dissatisfied
Extremely Satisfied
Satisfaction With Counseling as a Career:
Are you participating in a peer consultation group?
15.If participating in a peer consultation group, what types of activities do you participate in? Please check all that apply.
16.Estimated hours per week devoted to designated activites:
0
1-5
6-10
11-15
16-20
21+
Counseling/Psychotherapy
Academic/Teaching
Supervision
Consulting
Administration
Research
Diagnostic/Assessment
Vocational Counseling
Behavioral Management
17.Please list any other activites and hours devoted to them, if not listed above:
18.Please indicate what type and how many hours/week are devoted to the following counseling/therapeutic activites?
0
1-5
6-10
11-15
16-20
21+
Individual
Marital
Family
Group
Estimated hours /week devoted to informal or formal research activites:
How do you evaluate the effectiveness of
clinical interventions and/or clinical outcomes?
What percentage of your clients receive medicaid funding for their mental health care?
How long have you been an approved provider for a managed care company?
23.Please indicate to what degree you agree or disagree with the following statments:
Strongly agree
Moderately agree
Somewhat agree
Somewhat disagree
Moderately agree
Strongly disagree
I can contribute to decisions that impact my work on the job:
24.
Stronly agree
Moderately agree
Somewhat agree
Somewhat disagree
Moderately disagree
Stronly disagree
I can exercise as much autonomy as I like within my current position:
25.
Strongly agree
Moderately agree
Somewhat agree
Somewhat disagree
Moderately disagree
Strongly disagree
I am satisfied with the opportunities I am currently provided to utilize my skills and abilities:
26.
Stronly agree
Moderately agree
Somewhat agree
Somewhat disagree
Moderately disagree
Strongly disagree
I am likely to be in the position I am currently working within a year from now.
27.
Everyday
Once per week
Every month
Every three months
Every six months
Rarely or never
How often do you feel emotionally drained from your work?
28.
If any of the survey questions were unclear, confusing, or otherwise difficult to answer, please indicate the question numbers to the right:

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