[e.g. Satisfaction] SCALE SURVEY

1	Not important at all	
2	Somewhat unimportant	
3	No opinion either way	
4	Somewhat Important	
5	Extremely Important	

Name :		
Age :		
Gender :		

For each question below, circle the number to the right that best fits your opinion on the importance of the issue.  Use the scale above to match your opinion. 

Question	Scale	
1.	Add your own question	1	2	3	4	5	
2.	Add your own question	1	2	3	4	5	
3.	Add your own question	1	2	3	4	5	
4.	Add your own question	1	2	3	4	5	
5.	Add your own question	1	2	3	4	5	
6.	Add your own question	1	2	3	4	5	
7.	Add your own question	1	2	3	4	5	
8.	Add your own question	1	2	3	4	5	
9.	Add your own question	1	2	3	4	5	
10.	Add your own question	1	2	3	4	5	
11.	Add your own question	1	2	3	4	5	
12.	Add your own question	1	2	3	4	5