| 1. Do I feel good about myself? | Yes | Sometimes | Not Sure | Never |
| 2. Do I take part in group discussions? | Yes | Sometimes | Not Sure | Never |
| 3. Do I know why I'm someone special? | Yes | Sometimes | Not Sure | Never |
| 4. Do I know what put-ups/put-downs are
and how they make people feel? | Yes | Sometimes | Not Sure | Never |
| 5. Do I know how to express my anger
without hurting myself or others? | Yes | Sometimes | Not Sure | Never |
| 6. Do I know how to be a good friend? | Yes | Sometimes | Not Sure | Never |
| 7. Do I know what peer pressure is? | Yes | Sometimes | Not Sure | Never |
| 8. Can I give myself put-ups? | Yes | Sometimes | Not Sure | Never |
| 9. Do I cooperate with others? | Yes | Sometimes | Not Sure | Never |
| 10. Do I know why it's important to
to talk about my feelings? | Yes | Sometimes | Not Sure | Never |
| 11. Do I know what I look for in a friend? | Yes | Sometimes | Not Sure | Never |
| 12. Do I help others? | Yes | Sometimes | Not Sure | Never |
| 13. Am I truthful and honest? | Yes | Sometimes | Not Sure | Never |
| 14. Do I know what I'm good at? | Yes | Sometimes | Not Sure | Never |
| 15. Do I know what I need to work on? | Yes | Sometimes | Not Sure | Never |
| 16. Do I know what I value? | Yes | Sometimes | Not Sure | Never |
