









Please tick the appropriate column.
- | |
---|---|
1 - very important 2 - important 3 - not very important 4 - unimportant |
|
to broaden one's outlook | |
to help one socially | |
to train one for a specific job or profession | |
to enjoy oneself | |
to meet a wide variety of different people | |
to give one a chance to read widely | |
to train one's mind | |
to improve one's knowledge and conversation | |
to improve one's earning capacity | |
to give one time to decide on one's career | |
to join many societies | |
to get a good degree | |
to meet people who may be useful in later life | |
to give one a chance to meet and talk with students reading other disciplines | |
to meet lecturers who have a profound knowledge of your subject |

- | |
---|---|
1 - always 2 - frequently 3 - sometimes 4 - seldom 5 - never |
|
When reading do you find that you reach a point where you are mechanically registering the actual words rather than their meaning? | |
Are you prevented from study by visitors or friends dropping in? | |
When you have set aside a time for study, do you have difficulty in settling down to it? | |
Have you been handicapped by illness while studying? | |
Do you find yourself too tired or listless to study efficiently? | |
Do you find prolonged study gives rise to headaches? | |
Do you actively participate in discussions during tutorials? | |
Do you find difficulty in expressing your ideas? | |
Are you conscientious about writing up lecture notes while the subject matter is fresh in your mind? | |
Do you find difficulty in concentrating your attention on the subject matter of lectures? | |
Do you spend an undue amount of time at the beginning of each examination paper before you 'get into your stride'? | |
Do you find more difficulty in expressing your ideas under examination conditions than in ordinary written work? | |
Do you find difficulty during examinations in portioning out your effort to cover the minimum number of questions adequately? | |
Do you feel that your examination performance is lowered by 'examination nerves' or anxiety? |







What sort of trouble do you have?
(If necessary circle more than one number)
- | |
---|---|
1 - Yes 2 - ? 3 - No |
|
Are you happiest when you get involved in some project that calls for rapid action? | |
Do you sometimes feel happy, sometimes depressed, without any apparent reason? | |
Does your mind often wander while you are trying to concentrate? | |
Do you usually take the initiative in making new friends? | |
Are you inclined to be quick and sure in your actions? | |
Are you frequently 'lost in thought' even when supposed to be taking part in a conversation? | |
Are you sometimes bubbling over with energy and sometimes very sluggish? | |
Would you rate yourself as a lively individual? | |
Would you be very unhappy if you were prevented from making numerous social contacts? | |
Are you inclined to be moody? | |
Do you have frequent ups and downs in mood, either with or without apparent cause? | |
Do you prefer action to planning for action? |


Type of injury (enter as BURN, SCALD, BROKEN BONE, CUT, etc.) | Part or parts injured | Age when injured (in years and months) | Treatment Hos.I.P, Hos.O.P, Nursing Home, Own Home | If treated in own home, who gave treatment? (Doctor, Nurse, other) | Details of remaining scarring, disability or deformity | |
---|---|---|---|---|---|---|
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First Accident 1 | ||||||
Second 2 |

nshd_64_cmu
FOR THOSE WHOSE HOME ADDRESS HAS CHANGED
A. UNIVERSITY AND COURSE
B. BACKGROUND INFORMATION
We are interested to know what you think about the functions of a University course and their relative importance. How would you rate the importance of the following aspects or functions of such a course?
- | |
---|---|
1 - very important 2 - important 3 - not very important 4 - unimportant |
|
to broaden one's outlook | |
to help one socially | |
to train one for a specific job or profession | |
to enjoy oneself | |
to meet a wide variety of different people | |
to give one a chance to read widely | |
to train one's mind | |
to improve one's knowledge and conversation | |
to improve one's earning capacity | |
to give one time to decide on one's career | |
to join many societies | |
to get a good degree | |
to meet people who may be useful in later life | |
to give one a chance to meet and talk with students reading other disciplines | |
to meet lecturers who have a profound knowledge of your subject |
C. WORK AND ACTIVITIES
Please answer the following questions by ticking the appropriate column.
- | |
---|---|
1 - always 2 - frequently 3 - sometimes 4 - seldom 5 - never |
|
When reading do you find that you reach a point where you are mechanically registering the actual words rather than their meaning? | |
Are you prevented from study by visitors or friends dropping in? | |
When you have set aside a time for study, do you have difficulty in settling down to it? | |
Have you been handicapped by illness while studying? | |
Do you find yourself too tired or listless to study efficiently? | |
Do you find prolonged study gives rise to headaches? | |
Do you actively participate in discussions during tutorials? | |
Do you find difficulty in expressing your ideas? | |
Are you conscientious about writing up lecture notes while the subject matter is fresh in your mind? | |
Do you find difficulty in concentrating your attention on the subject matter of lectures? | |
Do you spend an undue amount of time at the beginning of each examination paper before you 'get into your stride'? | |
Do you find more difficulty in expressing your ideas under examination conditions than in ordinary written work? | |
Do you find difficulty during examinations in portioning out your effort to cover the minimum number of questions adequately? | |
Do you feel that your examination performance is lowered by 'examination nerves' or anxiety? |
D. TIMETABLE OF WORK
E. PERSONAL INFORMATION
F. BOOKS AND NEWSPAPERS
G. VACATION WORK
H. MISCELLANEOUS INFORMATION
Try and decide whether 'yes' or 'no' is how you usually feel and then circle the 'yes' or the 'no'. If you find it quite impossible to decide, then circle the '?',. However don't use the question-mark unless you feel you have to. Work quickly and don't spend too much time on any question, we want your first reaction.
- | |
---|---|
1 - Yes 2 - ? 3 - No |
|
Are you happiest when you get involved in some project that calls for rapid action? | |
Do you sometimes feel happy, sometimes depressed, without any apparent reason? | |
Does your mind often wander while you are trying to concentrate? | |
Do you usually take the initiative in making new friends? | |
Are you inclined to be quick and sure in your actions? | |
Are you frequently 'lost in thought' even when supposed to be taking part in a conversation? | |
Are you sometimes bubbling over with energy and sometimes very sluggish? | |
Would you rate yourself as a lively individual? | |
Would you be very unhappy if you were prevented from making numerous social contacts? | |
Are you inclined to be moody? | |
Do you have frequent ups and downs in mood, either with or without apparent cause? | |
Do you prefer action to planning for action? |
I. GENERAL HEALTH
Please give the following details about each accident, starting with the earliest:
Type of injury (enter as BURN, SCALD, BROKEN BONE, CUT, etc.) | Part or parts injured | Age when injured (in years and months) | Treatment Hos.I.P, Hos.O.P, Nursing Home, Own Home | If treated in own home, who gave treatment? (Doctor, Nurse, other) | Details of remaining scarring, disability or deformity | |
---|---|---|---|---|---|---|
Generic textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric text | Generic textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric text | Generic textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric text | Generic textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric text | Generic textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric text | Generic textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric text | |
First Accident 1 | ||||||
Second 2 |
Please give the following details about each accident, starting with the earliest:
DETAILS of how each ACCIDENT OCCURRED (if burnt by fire say whether electric, gas, open fire or oil stove) | Where it occurred (own home, school, street, etc.,) | |
---|---|---|
Generic textGeneric textGeneric textGeneric text | Generic textGeneric textGeneric textGeneric text | |
First Accident 1 | ||
Second 2 |
1964 University Questionnaire