The Multicultural Quality of Life Index Name(Required) First Last Email(Required) Instructions: Please indicate the quality of your health and life at present, from "poor" to "excellent", by selecting any of the ten points on the line for each of the following items:1. Physical Wellbeing (feeling energetic, free of pain and physical problems)(Required)Poor 123456789Excellent 102. Psychological/Emotional Wellbeing (feeling good, comfortable with yourself)(Required)Poor 123456789Excellent 103. Self-Care and Independent Functioning (carrying out daily living tasks; making own decisions)(Required)Poor 123456789Excellent 104. Occupational Functioning (able to carry out work, school and homemaking duties)(Required)Poor 123456789Excellent 105. Interpersonal Functioning (able to respond and relate well to family, friends, and groups)(Required)Poor 123456789Excellent 106. Social-Emotional Support (availabiltiy of people you can trust and who can offer help and emotional support)(Required)Poor 123456789Excellent 107. Community and Services Support (pleasant and safe neighborhood, access to financial, informational, and other resources)(Required)Poor 123456789Excellent 10 8. Personal Fulfillment (experiencing a sense of balance, dignity, and solidarity; enjoying sexuality, the arts, etc.)(Required)Poor 123456789Excellent 109. Spiritual Fulfillment (experiencing faith, religiousness, and transcendence beyond ordinary material life)(Required)Poor 123456789Excellent 1010. Global Perception of Quality of Life (feeling satisfied and happy with your life in general)(Required)Poor 123456789Excellent 10How would you describe your relationship with yourself at the present time?If applicable, how would you describe your relationship with your partner at the present time?How would you describe your relationships in general?How hopeful are you that this program can be beneficial to you and your relationships?What do you hope to gain through participation in the SPICE program?12/12/2024 94947
