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2014, Winter
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Name ________________________
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We plan several questionnaires about your experiences and skills. Their purposes are to encourage you to relate Humboldt's life and work to your own, and to show what special qualities you might contribute to the course. This first questionnaire is a sampling of the kinds of items you will encounter in later questionnaires. Your grades on questionnaires are pass/no-pass, based solely on whether you did or did not do the questionnaire, not on the content of your responses. If you feel that an item invades your privacy, you need not respond to it.
Fill in blanks as indicated, noting units of measurement. For yes/no questions, either circle one of "y/n" (if it's there) or circle/√checkmark the item itself to mean "yes", or cross it out to mean "no". (Do NOT use underscores to indicate "yes".) If you want, you can use the extra space to the right of each question to record brief responses. It is all right to provide approximate answers. At the end of the questionnaire is a short activity that will produce a writing sample and the start of a class discussion.
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TRAVEL EXPERIENCE: Have you ever been to… ? (other than passing through an airport)
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Europe; the Caribbean; Mexico; Central America; South America; the American Southwest (other than California)
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TRAVEL EXPERIENCE: Have you ever traveled between one country and another…
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on foot; on a bicycle; by riding an animal; by boat
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GENERAL OUTDOORS EXPERIENCE: What is the total number of nights you have slept outdoors [answer at right]?
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in total_____; in one consecutive stretch____; by yourself (= no one within calling distance)____; (tent counts, heated cabin with running water does not)
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GENERAL OUTDOORS EXPERIENCE: Have you ever…?
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drunk from a stream; pitched a tent; split firewood; built a fire without matches or a lighter
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GENERAL OUTDOORS EXPERIENCE: Have you ever been to…
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the PDX zoo; another zoo; a botanical garden (or similar); waterlife aquarium; a nature preserve; a national park; a designated wilderness area
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LOCOMOTION ON FOOT: What is the greatest number of miles you have walked…?
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in one 24-hour period_____
over an extended period: _____ miles in _____ days
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LOCOMOTION (OTHER): Have you ever…?
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paddled a canoe; rowed a boat; sailed a boat; driven a powerboat; skied; ice-skated; rappelled; windsurfed; parachuted; hangglided; ballooned; flown a plane
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LOCOMOTION (OTHER): What is the greatest altitude (1 mile=approx. 5000 feet) you have reached…?
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on foot / horseback / bike (any of those)______
in a powered vehicle other than an airplane______
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LOCOMOTION (OTHER): How far have you looked straight down (without being in an airplane)?
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________ (specify feet, miles, etc.), and from where/ what_________________ (tree, climbing wall, mountain cliff, etc.)
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LOCOMOTION (OTHER): What is the greatest distance you have swum? (indicate units: laps, yds/meters, mi./km)
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in a swimming pool in one stretch_____
outdoors without touching bottom_____
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LOCOMOTION (OTHER): Have you ever used…?
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swim mask, fins, snorkel; scuba equipment
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LOCOMOTION (OTHER): Have you ever…?
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used a paper map of a large area (forest, state, etc.); used a compass; paced off a distance; used GPS
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LOCOMOTION (OTHER): Have you ever gotten lost outside a built-up area?
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y / n; if yes, how long were you lost and how did you get out of being lost?
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HEALTH: How do you rate your general health?
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excellent; good; average; poor; very poor
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HEALTH: How do you rate your physical fitness?
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iron person; jock(ette); reasonably fit; could be reasonably fit with a few workouts; couch potato
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HEALTH: Have you ever been close to dying because of…?
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illness; accidental injury; hostilities
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HEALTH: What is the longest time (in days or fractions of days) you have gone without…?
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food_____; water_____; sleep_____; bathing_____; talking_____; seeing another human being_____; reading_____
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HEALTH: Have you ever…?
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had a fever above 100 degrees; had stitches; broken a bone; been in a coma
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HEALTH: Have you ever had a "tropical" disease?
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y / n; If so, what was it, and how serious?
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HEALTH: Have you had training in…?
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basic first aid; aquatic livesaving; CPR; first response
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HEALTH: Have you ever ________ first aid away from a built-up area?
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given; received
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HEALTH: Have you ever…?
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made a medicine for yourself
taken such a hand-made medicine
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PLANTS & ANIMALS: Have you ever _______ a wild plant?
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gathered; eaten; If so, what was it? (Garden-grown vegetables do not count.)
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PLANTS & ANIMALS: Have you ever…?
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planted a garden; lived/ worked on a farm; planted a tree; cut down a tree
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PLANTS & ANIMALS: Have you ever touched a…?
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fish; reptile; bird; rodent; larger mammal
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PLANTS & ANIMALS: Have you ever killed a…?
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fish; reptile; bird; rodent; larger mammal
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PLANTS & ANIMALS: Have you ever…?
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dissected a plant; dissected an animal; touched a fossil
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ENVIRONMENTS & LOCATONS: Have you ever been _______? If so, where?
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south of the equator; in the Arctic / Antarctic
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ENVIRONMENTS & LOCATONS: Have you ever experienced total…?
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darkness
silence
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ENVIRONMENTS & LOCATIONS: How many _____ do you think you can identify without a reference resource?
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rocks_____; flowers_____; trees_____; mushrooms_____; insects / arachnids_____; fish_____; constellations_____; individual stars_____; individual planets_____
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WEATHER, CLIMATE, & EXTREME NATURAL EVENTS: What extremes of temperatures you have experienced outdoors?
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highest (degrees F):
lowest (degrees F):
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WEATHER, CLIMATE, & EXTREME NATURAL EVENTS: Have you ever been in / very near a/an…?
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earthquake (Richter Scale:____?); live volcano; hurricane; tornado; large-scale flood; flash flood; blinding sandstorm; avalanche; iceberg; cave
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WEATHER, CLIMATE, & EXTREME NATURAL EVENTS: What is the nearest you have been to a lightning stroke?
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_____ (unit: ______); to estimate: 1 second between lightning & thunder = 1000 feet)
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THE MACROCOSM: Have you ever seen a/an/the…?
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Milky Way; solar eclipse; lunar eclipse; planet (other than Earth); comet; meteor; meteorite; aurora ("Northern / Southern Lights")
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THE MICROCOSM: Have you ever looked through a ______? If so, what did you see?
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microscope; electron microscope; telescope
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PEOPLE: Have you ever interacted with an indigenous / aboriginal person on that person's territory?
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y / n; If so, who and where, and in what language or other means of communication?
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PEOPLE: Have you ever lived under a different form of government? (China vs. US counts; Bush vs. Obama does not)
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y / n; If so, where and when?
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PEOPLE: Do you regard yourself as…?
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multilingual; multicultural; multiracial; multifaith
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PEOPLE: In your life have you changed your…?
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total outlook; religion; major moral beliefs; political affiliation
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ARTIFACTS, TOOLS, INSTRUMENTS: Have you ever _______ an arrowhead or similar artifact?
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seen; touched; made
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ARTIFACTS, TOOLS, INSTRUMENTS: Have you ever _____ a piece of clothing?
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sewn; woven; knitted; crocheted; dyed; mended;
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ARTIFACTS, TOOLS, INSTRUMENTS: Have you ever repaired a possession made of…?
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metal; wood; leather; glass or ceramic
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ARTIFACTS, TOOLS, INSTRUMENTS: Have you ever shot a…?
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rifle; shotgun; pistol; bow & arrow; crossbow
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ARTIFACTS, TOOLS, INSTRUMENTS: Have you ever built & used a…?
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musical instrument
scientific instrument
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ARTIFACTS, TOOLS, INSTRUMENTS: Have you ever read a…?
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liquid thermometer; blood-pressure meter; barometer; carpenter's level
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ARTIFACTS, TOOLS, INSTRUMENTS: Have you ever…?
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conducted your own scientific experiment; done so with a living being / yourself as the subject
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Please feel free to create and answer up to 3 of your own similar questions and answers, especially if you feel this questionnaire has neglected your areas of experience and expertise:
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1)
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2)
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3)
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