Personal Values Questionnaire

Instructions:

Following this instruction sheet, you will find 5 additional pages. Each page includes one of the Values Domains
(areas of your life you may find important) listed below, in order.

Values Domains:

1. Empathy
2. Creativity and Innovation
3. Result Orientation
4. Collaboration and Teamwork
5. Ethics and Morality

On each page that follows, please read carefully through the values domain description and write down YOUR
values (ways of living and doing things related to that Values Domain that are very important to you) where
indicated.

Below each of the values that you write down, you will see a series of 9 questions asking different things about
those individual values. Please answer each of these questions by circling the numbers that are true for you, on
each page that you list a personal value.

If you have any questions about how to complete this questionnaire, please ask the person who handed them out
to you.

Remember: Your name will not be on this questionnaire, so no one will know what values you write
down. Because of this, please describe your values as if no one will ever see this worksheet.

Personal Value #1: Empathy

Instructions: If this is an area of your life that is very important to you, describe the person you would most like to be in your
relationships with others (do not include Couples/Romantic Relationships). For example, some people who value empathy will be
more sensitive to others’ feelings, supportive, and attentive —but you should decide for yourself what kind of person you value being
in your Empathy domain.

Please write down your Empathy values here:

__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________

Please answer the following questions by circling the number (on the right) that is true for you:

1 2 3 4 5
1. How important is this value to you? A little bit Moderately Quite Extremely
Not at all
important important important important important

2. How committed are you to living this 1 2 3 4 5

value? Not at all Slightly Moderately Quite Extremely
committed committed committed committed committed

3. Right now, would you like to improve 2 3 4 5

1 A little bit Moderately so Quite a bit Extremely so
your progress on this value? Not at all

4. In the last 10 weeks, I have been 1 2 3 4 5

this successful in living this value: 0-20% 21-40% 41-60% 61-80% 81-100%
Successful Successful Successful Successful Successful

5. I value this because:

a. Other people would be upset with 3
1 2 4 5
me if these values were not important to Neither
Strongly Moderately Moderately Strongly
me. Disagree nor
Disagree Disagree Agree Agree
Agree

3
1 2 4 5
Neither
b. I would feel guilty or ashamed if Strongly Moderately Moderately Strongly
Disagree nor
these values were not important to me. Disagree Disagree Agree Agree
Agree

3
1 2 4 5
Neither
c. These values are important to me, Strongly Moderately Moderately Strongly
Disagree nor
whether or not others agree Disagree Disagree Agree Agree
Agree

3
d. Living consistently with these values 1 2 4 5
Neither
makes my life more meaningful Strongly Moderately Moderately Strongly
Disagree nor
Disagree Disagree Agree Agree
Agree

3
1 2 4 5
e. I experience fun and enjoyment Neither
Strongly Moderately Moderately Strongly
when I live consistently with these Disagree nor
Disagree Disagree Agree Agree
values. Agree

Personal Value #2: Creativity and Innovation

Instructions: If this is an area of your life that is very important to you, describe the person you would most like to be in living
these values. For example, some people who value creativity and innovation will look for qualities like autonomous, self-starter,
intelligent, and proactive—but you should decide for yourself what kind of person you value being in your Creativity and Innovation
domain..

Please write down your Creativity and Innovation values here:

__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________

Please answer the following questions by circling the number (on the right) that is true for you:

1 2 3 4 5
1. How important is this value to you? A little bit Moderately Quite Extremely
Not at all
important important important important important

2. How committed are you to living this 1 2 3 4 5

value? Not at all Slightly Moderately Quite Extremely
committed committed committed committed committed

3. Right now, would you like to improve 2 3 4 5

1 A little bit Moderately so Quite a bit Extremely so
your progress on this value? Not at all

4. In the last 10 weeks, I have been 1 2 3 4 5

this successful in living this value: 0-20% 21-40% 41-60% 61-80% 81-100%
Successful Successful Successful Successful Successful

5. I value this because:

a. Other people would be upset with 3
1 2 4 5
me if these values were not important to Neither
Strongly Moderately Moderately Strongly
me. Disagree nor
Disagree Disagree Agree Agree
Agree

3
1 2 4 5
b. I would feel guilty or ashamed if Neither
Strongly Moderately Moderately Strongly
these values were not important to me. Disagree nor
Disagree Disagree Agree Agree
Agree

3
1 2 4 5
c. These values are important to me, Neither
Strongly Moderately Moderately Strongly
whether or not others agree Disagree nor
Disagree Disagree Agree Agree
Agree

3
d. Living consistently with these values 1 2 4 5
Neither
makes my life more meaningful Strongly Moderately Moderately Strongly
Disagree nor
Disagree Disagree Agree Agree
Agree

3
e. I experience fun and enjoyment 1 2 4 5
Neither
when I live consistently with these Strongly Moderately Moderately Strongly
Disagree nor
values. Disagree Disagree Agree Agree
Agree

Personal Value #3: Result Orientation

Instructions: If this is an area of your life that is very important to you, describe the person you would most like to be in this
sense. For example, some people who are result oriented value motivation, client focus, and quality work—but you should decide for
yourself what kind of person you value being in the area of Result Orientation.

Please write down your Result Orientation values here:

__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________

Please answer the following questions by circling the number (on the right) that is true for you:

1 2 3 4 5
1. How important is this value to you? A little bit Moderately Quite Extremely
Not at all
important important important important important

2. How committed are you to living this 1 2 3 4 5

value? Not at all Slightly Moderately Quite Extremely
committed committed committed committed committed

3. Right now, would you like to improve 2 3 4 5

1 A little bit Moderately so Quite a bit Extremely so
your progress on this value? Not at all

4. In the last 10 weeks, I have been 1 2 3 4 5

this successful in living this value: 0-20% 21-40% 41-60% 61-80% 81-100%
Successful Successful Successful Successful Successful

5. I value this because:

a. Other people would be upset with 3
1 2 4 5
me if these values were not important to Neither
Strongly Moderately Moderately Strongly
me. Disagree nor
Disagree Disagree Agree Agree
Agree

3
1 2 4 5
b. I would feel guilty or ashamed if Neither
Strongly Moderately Moderately Strongly
these values were not important to me. Disagree nor
Disagree Disagree Agree Agree
Agree

3
1 2 4 5
c. These values are important to me, Neither
Strongly Moderately Moderately Strongly
whether or not others agree Disagree nor
Disagree Disagree Agree Agree
Agree

3
d. Living consistently with these values 1 2 4 5
Neither
makes my life more meaningful Strongly Moderately Moderately Strongly
Disagree nor
Disagree Disagree Agree Agree
Agree

3
e. I experience fun and enjoyment 1 2 4 5
Neither
when I live consistently with these Strongly Moderately Moderately Strongly
Disagree nor
values. Disagree Disagree Agree Agree
Agree
Personal Value #4: Collaboration and Teamwork
Instructions: If this is an area of your life that is very important to you, describe the person you would most like to be in this
area. For example, some people value collaboration and teamwork because it allows them to be trustful and encouraging—but you
should decide for yourself what kind of person you value being in your Collaboration and Teamwork domain.

Please write down your Collaboration and Teamwork values here:

__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________

Please answer the following questions by circling the number (on the right) that is true for you:

1 2 3 4 5
1. How important is this value to you? A little bit Moderately Quite Extremely
Not at all
important important important important important

2. How committed are you to living this 1 2 3 4 5

value? Not at all Slightly Moderately Quite Extremely
committed committed committed committed committed

3. Right now, would you like to improve 2 3 4 5

1 A little bit Moderately so Quite a bit Extremely so
your progress on this value? Not at all

4. In the last 10 weeks, I have been 1 2 3 4 5

this successful in living this value: 0-20% 21-40% 41-60% 61-80% 81-100%
Successful Successful Successful Successful Successful

5. I value this because:

a. Other people would be upset with 3
1 2 4 5
me if these values were not important to Neither
Strongly Moderately Moderately Strongly
me. Disagree nor
Disagree Disagree Agree Agree
Agree

3
1 2 4 5
b. I would feel guilty or ashamed if Neither
Strongly Moderately Moderately Strongly
these values were not important to me. Disagree nor
Disagree Disagree Agree Agree
Agree

3
1 2 4 5
c. These values are important to me, Neither
Strongly Moderately Moderately Strongly
whether or not others agree Disagree nor
Disagree Disagree Agree Agree
Agree

3
d. Living consistently with these values 1 2 4 5
Neither
makes my life more meaningful Strongly Moderately Moderately Strongly
Disagree nor
Disagree Disagree Agree Agree
Agree

3
e. I experience fun and enjoyment 1 2 4 5
Neither
when I live consistently with these Strongly Moderately Moderately Strongly
Disagree nor
values. Disagree Disagree Agree Agree
Agree
Personal Value #5: Ethics and Morality
Instructions: If this is an area of your life that is very important to you, describe the person you would most like to be with
respect to moral standards. For example, some people who value ethics and morality will search for qualities like honesty, taking
responsibility or integrity—but you should decide for yourself what kind of person you value being with respect to Ethics and Morality.

1. Please write down your Ethics and Morality values here:

__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________

Please answer the following questions by circling the number (on the right) that is true for you:

1 2 3 4 5
1. How important is this value to you? A little bit Moderately Quite Extremely
Not at all
important important important important important

2. How committed are you to living this 1 2 3 4 5

value? Not at all Slightly Moderately Quite Extremely
committed committed committed committed committed

3. Right now, would you like to improve 2 3 4 5

1 A little bit Moderately so Quite a bit Extremely so
your progress on this value? Not at all

4. In the last 10 weeks, I have been 1 2 3 4 5

this successful in living this value: 0-20% 21-40% 41-60% 61-80% 81-100%
Successful Successful Successful Successful Successful

5. I value this because:

a. Other people would be upset with 3
1 2 4 5
me if these values were not important to Neither
Strongly Moderately Moderately Strongly
me. Disagree nor
Disagree Disagree Agree Agree
Agree

3
1 2 4 5
b. I would feel guilty or ashamed if Neither
Strongly Moderately Moderately Strongly
these values were not important to me. Disagree nor
Disagree Disagree Agree Agree
Agree

3
1 2 4 5
c. These values are important to me, Neither
Strongly Moderately Moderately Strongly
whether or not others agree Disagree nor
Disagree Disagree Agree Agree
Agree

3
d. Living consistently with these values 1 2 4 5
Neither
makes my life more meaningful Strongly Moderately Moderately Strongly
Disagree nor
Disagree Disagree Agree Agree
Agree

3
e. I experience fun and enjoyment 1 2 4 5
Neither
when I live consistently with these Strongly Moderately Moderately Strongly
Disagree nor
values. Disagree Disagree Agree Agree
Agree