The following survey has 50 word pairs that describe communication behavior. The participant will be taking the Keys of Communication course and would like feedback from you. Your feedback will be combined with the feedback of four other people. None of your responses will be shared with the participant or with anyone else – the participant will be receiving only a composite of all respondents’ feedback. Would you please take a few minutes to fill out the survey and return it today?

The word pairs are opposites with five circles between them. To explain the scale, following is an example using the first word pair of the survey.

As you work through the survey, sometimes you may feel that you have seen the same word before. This will not be the case, so do not look at previous answers when completing the survey. Make each item an independent judgment. Do not take too long when considering a word pair, as initial feelings are often the most accurate.

Please check the box for each word pair that best describes the participant’s communication. Thank you.