Program Pre-evaluation

Using the scale below, please rate the following aspects of your experience:

5-Strongly Agree  4-Mostly Agree  3-Somewhat Agree  2-Mostly Disagree  1-Strongly Disagree

Full Name
Email Address
Phone Number
I feel that I will have a wonderful personal future.
I feel very good about myself.
I know what my personal strengths and talents are.
When I am extremely angry with someone I know how to control my temper.
I am able to express myself effectively with adults in positions of authority.
I am willing to listen to the viewpoints of others.
I work well in a group.
When I make a mistake, I take responsibility for my actions.
I consider myself a leader.
I look for opportunities to make positive change in my community.
I am able to keep a positive attitude when faced with setbacks/disappointments.
I am open to constructive criticism from others.
It is difficult for me to trust others in my community who are different than me (race, religion).
I think it is important to have friends who have different backgrounds than me.
Please answer the simple math question below to submit the form.
2 + 2 =