<HTML>
<TITLE>Self-Esteem Test</TITLE>
<FONT FACE = 'arial' SIZE = '2'>
<B>This page is designed to assess your self-esteem.</B><BR>
<BR>
Please answer the following
questions. Once you have
answered each question,
click the button labeled <I> calculate my score.</I> The web page will then calculate
your self-esteem score, and tell you more about how you compare to
others.<BR><BR>
<FORM ACTION = '/cgi-bin/self-esteem3.pl' METHOD = 'post' >
1. I feel that I'm a person of worth, at least on an equal plane with
others.<BR>
Strongly Disagree
<INPUT TYPE = 'radio' NAME = 'v01' value = '1' >
<INPUT TYPE = 'radio' NAME = 'v01' value = '2' >
<INPUT TYPE = 'radio' NAME = 'v01' value = '3' >
<INPUT TYPE = 'radio' NAME = 'v01' value = '4' >
<INPUT TYPE = 'radio' NAME = 'v01' value = '5' >
Strongly Agree<BR><BR>
2. I feel that I have a number of good qualities.<BR>
Strongly Disagree
<INPUT TYPE = 'radio' NAME = 'v02' value = '1' >
<INPUT TYPE = 'radio' NAME = 'v02' value = '2' >
<INPUT TYPE = 'radio' NAME = 'v02' value = '3' >
<INPUT TYPE = 'radio' NAME = 'v02' value = '4' >
<INPUT TYPE = 'radio' NAME = 'v02' value = '5' >
Strongly Agree<BR><BR>
3. All in all, I am inclined to feel that I am a failure.<BR>
Strongly Disagree
<INPUT TYPE = 'radio' NAME = 'v03' value = '1' >
<INPUT TYPE = 'radio' NAME = 'v03' value = '2' >
<INPUT TYPE = 'radio' NAME = 'v03' value = '3' >
<INPUT TYPE = 'radio' NAME = 'v03' value = '4' >
<INPUT TYPE = 'radio' NAME = 'v03' value = '5' >
Strongly Agree<BR><BR>
4. I am able to do things as well as most other people.
<BR>
Strongly Disagree
<INPUT TYPE = 'radio' NAME = 'v04' value = '1' >
<INPUT TYPE = 'radio' NAME = 'v04' value = '2' >
<INPUT TYPE = 'radio' NAME = 'v04' value = '3' >
<INPUT TYPE = 'radio' NAME = 'v04' value = '4' >
<INPUT TYPE = 'radio' NAME = 'v04' value = '5' >
Strongly Agree<BR><BR>
5. I feel I do not have much to be proud of.
<BR>
Strongly Disagree
<INPUT TYPE = 'radio' NAME = 'v05' value = '1' >
<INPUT TYPE = 'radio' NAME = 'v05' value = '2' >
<INPUT TYPE = 'radio' NAME = 'v05' value = '3' >
<INPUT TYPE = 'radio' NAME = 'v05' value = '4' >
<INPUT TYPE = 'radio' NAME = 'v05' value = '5' >
Strongly Agree<BR><BR><BR>
<INPUT TYPE = 'submit' VALUE = 'Calculate my score'>
</FORM></FONT></HTML>