Project OZO : this document is a part of the preparation for the project Pilot. The project is co-funded by the Erasmus+ Programme of the European Union. The content in this document only reflects the views of the project responsibles. The European Commission is in no way responsible for any use that may be made of the information it contains.

1. Project number: 2016-2-NL01-KA104-034912
Project title: Bottom-up online zelfhulp voor
ouders met een achterstand (OZO)
P a g e | 1
The content in this document only reflects the views of the
project responsibles. The European Commission is in no way
responsible for any use that may be made of the information it
contains.
PILOT QUESTIONNAIRE
(for participants)
Version: 2.1
Date: 3.5.2018
Author: Onno Hansen-Staszyński (Ezzev Foundation)

2. Project number: 2016-2-NL01-KA104-034912
Project title: Bottom-up online zelfhulp voor
ouders met een achterstand (OZO)
P a g e | 2
The content in this document only reflects the views of the
project responsibles. The European Commission is in no way
responsible for any use that may be made of the information it
contains.
Introduction
Please fill out this questionnaire twice: once in advance of the first structured chat session and once
again after the last structured chat session.
When filling out the questionnaire after the last structured chat session, please do not consider the
answers you’ve provided the first time. It is crucial that you answer the questions in such a way that
they represent the moment in which you fill them out.
The questionnaire outcomes will be anonymized.

3. Project number: 2016-2-NL01-KA104-034912
Project title: Bottom-up online zelfhulp voor
ouders met een achterstand (OZO)
P a g e | 3
The content in this document only reflects the views of the
project responsibles. The European Commission is in no way
responsible for any use that may be made of the information it
contains.
The questionnaire
1. Please provide an avatar (a sign, a letter, a drawing) that allows to identify your questionnaires
before and after as belonging together without disclosing your real identity:
2. Please indicate whether you agree with the following ten statements on a scale of “1” to “5” – “1“
indicating that you totally disagree and “5” that you totally agree.
1
(I totally
disagree)
2
(I disagree)
3
(I am
neutral)
4
(I agree)
5
(I totally
agree)
1 I hate to fail
2 I love to learn new
things
3 I take comments very
personal
4 I try to avoid problems
5 If I feel insecure about
something I want to
find out why
6 I’m tired of getting new
information all the
time
7 It’s important for me to
look smart
8 I like things to be stable
9 I see criticism as an
encouragement
10 I am who I am