Audience Survey Form
Sex: M F Age ______ GPA ________
Marital Status _____________ Religious Preference________________________
Major ____________________ State lived in longest ________________________
Current job: (full or part-time) ______________________ Hours per week ____________
Career Aspirations: ________________________________________________________
Persons
I admire most: (Male) ______________________ (Female) _________________
Politically,
I consider myself: liberal, conservative, moderate; Democrat, Republican,
other
(circle one)
(circle one)
Group
Memberships (occupational, political, religious, or social)____________________
Father’s
occupation __________________ Mother’s occupation____________________
Place of birth _____________________ Places lived ______________________________
__________________________________________________________________________
Travel (in USA) _____________________________________________________________
Travel (outside USA) ________________________________________________________
Hobbies __________________________________________________________________
Positive "trigger words" _____________________________________________________
Negative "trigger words" ____________________________________________________
The
most important thing in my life right now is __________________________________
Topics on which I would like to hear an informative speech (name 3)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
Topics on which I would like to hear a persuasive speech (name 3)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________