Forced-Choice Reinforcement Menu Student Questionnaire Template

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Name: ______________________________________________________
In order to identify possible classroom reinforcers, it is important to go directly to the source, namely,
you the student. Below is a paragraph that provides instructions for completing a series of “controlled
choice” survey items about individual reinforcement preferences. Please read the following paragraph
carefully:
“Let’s suppose that you have worked hard on an assignment and you think that you have done a
super job on it. In thinking about a reward for your effort, which one of the two things below
would you most like to happen? Please choose the one from each pair that you would like best
and mark and “X” in the blank that comes in front of it. Remember, mark only one blank for each
pair.”
1.
_____
Teacher writes “100” on your paper. (A)
_____
Be first to finish your work. (CM)
2.
_____
A bag of chips. (CN)
_____
Classmates ask you to be on their team. (P)
3.
_____
Be free to do what you like. (I)
_____
Teacher writes “100” on your paper. (A)
4.
_____
Classmates ask you to be on their team. (P)
_____
Be first to finish your work. (CM)
5.
_____
Be free to do what you like. (I)
_____
A bag of chips. (CN)
6.
_____
Teacher writes “100” on your paper. (A)
_____
Classmates ask you to be on their team. (P)
7.
_____
Be first to finish your work. (CM)
_____
Be free to do what you like. (I)
8.
_____
A bag of chips. (CN)
_____
Teacher writes “100” on your paper. (A)
9.
_____
Classmates ask you to be on their team. (P)
_____
Be free to do what you like. (I)
10.
_____
Be first to finish your work. (CM)
_____
A bag of chips. (CN)
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