Name: ______________________________________ Gender: Male / Female
Age: _______________ Name of School: ______________________________________
Computer Games played: _________________________________________________
The words shown below describe different feelings and moods. Please use this
this list to describe your feelings at this moment.
If the word definitely describes your feelings, encircle letter A. If the word more
or less describes your feelings, encirlce letter B. If you cannot decide whether or
or not it descrbes how you feel, encircle letter C. If the word does not describe
the way you feel, encircle letter D.
First reactions are most reliable; therefore do not spend too long thinking about
each word. Please be as honest and accurate as possible.
1. Tense A B C D
2. Relaxed A B C D
3. Restful A B C D
4. Active A B C D
5. Apprehensive A B C D
6. Worried A B C D
7. Energetic A B C D
8. Drowsy A B C D
9. Bothered A B C D
10. Uneasy A B C D
11. Dejected A B C D
12. Nervous A B C D
13. Distressed A B C D
14. Vigorous A B C D
15. Peaceful A B C D
16. Tired A B C D
17. Idle A B C D
18. Up-tight A B C D
19. Alert A B C D
20. Lively A B C D
21. Cheerful A B C D
22. Contented A B C D
23. Jittery A B C D
24. Sluggish A B C D
25. Pleasant A B C D
26. Sleepy A B C D
27. Comfortable A B C D
28. Calm A B C D
29. Stimulated A B C D
30. Activated A B C D