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Age 
18-25 25-30 30-35 35-40 Other  
 
 
 
Gender 
Male Female
 
 
 
when meeting new people I am always 
 
excited
 
anxious
 
neutral
 
uncomfortable
 
Other
 
 
 
 
Presenting in front of others
 
does not bother me
 
I love doing it
 
I feel uncomfortable
 
Other
 
 
 
 
when being at the center of attention i feel judged
 
yes
 
no
 
depends
 
Other
 
 
 
 
I fear being excluded from groups
 
Yes
 
No
 
Depends
 
Other
 
 
 
 
do you consider yourself shy? 
 
Yes
 
No
 
Depends on the situation
 
Other
 
 
 
 
When being in a big group of people I conduct conversations
 
Always
 
Sometimes
 
Depends
 
Never
 
Other
 
 
 
 
Do you have any insecurities?
 
No
 
Yes
 
Other
 
 
 
 
When is it that you feel you are in your comfort zone
 
Around friends
 
Around Family
 
Around your significant other
 
Around those who are friendly towards you
 
Other