C:\MyFiles\457w99\MembSurvForm

Name: ________________ Group #: _________

{due by Friday Jan 22)

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Membership data, groups you CURRENTLY belong to

	Group Type*	Size	No. Men	No. Women	Age composition* C T YA MA SA
1.
2.
3.
4.
5.
6.
7.
8.

* Group type:

1=Athletic team 2=Work-related group 3=Academic group 4=Greek system

5=Religious group 6=Dorm/housemates 7=Choir/Band 8a= theatre

8b=Personal Enrichment 9=friends 10=social group 11=family

12=volunteer 13=political (includes environment, recycling)

* For age composition, enter how many of category in the group. Abbreviation key:

C= Children T=Teens

YA=Young adults (20s & 30s)

MA=Middle-aged adults (40s & 50s)

S=Senior adults (60s and older)

(TURN OVER)

For two of the groups you listed on the other side, please answer the following questions:

Group number (on other side) ____ ____

Please put the number that best matches each group:

A. Ethnic diversity:

1. Ethnically homogeneous (all African-American, or all European-American)

2. Homogeneous except for one member who is different

3. Several members who are ethnically different

4. Extremely diverse ethnically ____ ____

B. Meeting frequency:

1. Meet several times a week. 2. Meet once a week.

3. Meet a few times a month. 4. Meet once a month

5. Meet a few times a year ____ ____

C. How long group has been together:

1. Less than a month 2. About a month 3. A few months

4. A year 5. Several years 6. At least 10 years ____ ____

D. How long have you been a member? (Use same scale as for C.) ____ ____

E. Is the leader of your group:

1. Elected 2. Appointed 3. Emerged informally 4. No leader ____ ____

E. Conflict in this group is:

1. Nonexistent 2. Rare 3. Occasional 4. Frequent 5. Almost constant ____ ____

1. Mild 2. Moderate 3. Strong 4. Severe ____ ____

F. This group is very united

1. Strongly Disagree 2. Disagree Moderately 3. Disagree Slightly

4. Strongly Agree 5. Agree Moderately 6. Agree Slightly ____ ____

G. This group is very cohesive (Use same scale as for F) ____ ____