Spirituality Quotient Questionnaire

Prepared by Dr. Anie Kalayjian

Define spirituality: ____________________________________________________________
Define one’s spirit/soul:___________________________________________________
Is being spiritual different from being religious?
Yes __________ No ____________ Not sure ________________
Is being spiritual different from being moral?
Yes __________ No____________ Not sure________________
Please elaborate:_____________________________________________________________
Is being spiritual different from being superstitious?
Yes__________ No____________ Not sure________________
Can one tell if another is spiritual?
Yes__________ No____________ Not sure________________ If yes, how so?__________
How does one become spiritual? _________________________________________________
How does one gain knowledge about spirituality?_____________________________________
Where does one gain knowledge about spirituality?
Home_________ School____________ Church_____________
Other (specify)________________________________________________________________
10. Do you have any spiritual role models? Yes________ No________ Not sure___________________
If yes, please name:__________________________________________________________________
Do you consider yourself a spiritual being?
Yes_______ No_________ Not sure___________
Please elaborate: ____________________________________________________________________
Do you consider yourself a spiritual being?
Yes_______ No_________ Not sure___________
Please elaborate: ____________________________________________________________________
Do spirits die?
Yes_______ No_________ Not sure___________
Please elaborate: ____________________________________________________________________
Are spirits born?
Yes_______No_________ Not sure___________
Please elaborate: ____________________________________________________________________
Do you believe in life after death?
Yes_______ No_________ Not sure__________
Please elaborate: ____________________________________________________________________
How does one achieve spiritual balance?__________________________________________________
Are there benefits to being spiritual?
Yes_______ No_________ Not sure__________
Do you partake in organized religion?
Yes_______ No_________ If yes, denomination? _____________
Age: under 20_____ 20-29____ 30-39 ____ 40-49 _____ 50-59 ____ 60-69 ____ 70 & over ___
Gender: Male ____ Female ____
Education: Grammar sch. ____ High sch. _____ Some college ____ College grad ____ Grad sch _____
Place of Birth: ____ 22. Nationality: _____
Marital status: Single ____ Married ____ Widowed ____ Separated ____ Divorced ____
Employed? Yes ____ No _____ Part/time _____
Type of employment (please specify): __________________________________________________