Assessment

Please complete the Assessment to the right as thoroughly as possible and submit.  Your responses will be used to help you identify your strengths, interests, values, life goals, and potential threats to success. 

You will receive a CONFIDENTIAL Findings Report within 7 days.  If you would like to share the results with your parent(s), guardian, school administrator, or other, please indicate their name(s) and you may optionally include their email address below yours

Please use the "Additional Information" section at the end to share any relevant information that you feel may be helpful.  Please allocate at least 30 minutes to fully complete all assessment sections at once.

 

Name *
Name
I would like to share my Findings Report with the following. If there are additional names or special requests, please list them in the Additional Information section.
I would like to share my Findings Report with the following. If there are additional names or special requests, please list them in the Additional Information section.
Phone *
Phone
SECTION I: Student's Interest/Views. *
SECTION I: Student's Interest/Views.
1) Religion and/or spirituality are very important to me.
2) I feel safe with our county's current direction and leadership.
3) Becoming an entrepreneur better suits my personality than becoming a life-long employee.
4) I am very committed to exercise and work out for at least 30 minutes, 3 times/week.
5) I have high regard for the views of others (family, students, children, etc.)
6) I enjoy volunteering to help those less fortunate than me (feeding homeless, etc.)
7) I am much more fascinated by working with technology (science, computers, math, etc.) than with arts (music, art, dance, etc.)
8) I enjoy working with my hands to build and repair things (toys, home repair, cars, construction, etc.)
9) I do my best work when I work alone or in small groups.
10) I think everyone should be free to pursue their individual sexual preferences. It's a personal choice.
11) My school offers just the right sort of educational and developmental options.
12) I feel like my teachers and counselors sincerely care about my well-being.
13) National news of violence in schools is rare and it does not affect how I view my school or classmates.
SECTION II: Student's Early Childhood (Age 0 - 7): *
SECTION II: Student's Early Childhood (Age 0 - 7):
1) I was born in a hospital, without complication (induction, C-Section, premature, etc.).
2) I was born naturally, without medication.
3) I was breastfed during my first several months of life.
4) During pregnancy, my mother experienced smoking, alcohol, and/or drugs (prescription/non-prescription).
5) During pregnancy, my mother experienced unusual trauma (domestic violence, eviction/homelessness, court/incarceration, etc.).
6) At birth, my weight, height, and vital signs were normal.
7) During my first seven years, I experienced significant health issue(s), causing hospitalization. (If so, please elaborate in Additional Information section.)
8) My first seven years were generally easy and full of joy.
9) I was raised by both mother and father during my first seven years.
10) During first seven years, I never witnessed my parents fighting. They had a peaceful and loving relationship.
11) As an adult, I hope to pattern after my Mother.
12) As an adult, I hope to pattern after my Father.
SECTION III: Student's Social Behavior. *
SECTION III: Student's Social Behavior.
1) Overall, I have really enjoyed my educational experience, so far (elementary, middle, and/or high school).
2) During school years, my academic performance was excellent.
3) I have never received special/remedial education or repeated a grade.
4) I have high self-esteem and get along well with others.
5) I am always very respectful and rarely lose my temper or am defiant with my parents, teacher, and authority figures.
6) I am generally honest and rarely in trouble.
7) I seldom forget or misplace things.
8) I do not talk excessively, blurt things out, or interrupt others when speaking.
9) I have never been suspended or expelled from school.
10) I was never a street gang member.
11) I have never been destructive to property or set fires.
12) I have never been bullied or cyber-bullied.
13) I have never felt that I may have a problem with depression or anxiety.
14) I have never engaged in or considered self-harm seriously (cutting, suicide attempt, etc.).
15) I have never had a problem with hearing voices or seeing things that were not there.
16) Almost all students experiment with cigarettes, drugs, and alcohol. I am no different.
17) I do not feel that moderate use of drugs/alcohol will significantly affect one's school performance.
18) I was never arrested or involved with juvenile court.
19) I was never abusive to others (bullying, threatening, harming, etc.) -- not even for fun.
20) I have been diagnosed with Attention Deficit Disorder or Autism.
21) I have never been sexually abused or physically traumatized.
22) I have never witnessed domestic violence/aggression/spousal abuse among my parents or other adults in my life (shooting, stabbing, murder, etc.).
23) My eating habits are normal and I am not considered over or under weight (obese, anorexic, etc.)
24) In the past (or currently), I have been homeless, a part of the foster care or other government system.
25) In the past (or currently), my family has received government assistance (Food Stamps/SNAP, Assisted Living Support, etc.)
26) I sometimes scream, cry, or have temper tantrums, when agitated, frustrated, or things do not go my way.
27) I often prefer spending time alone in room while others socialize, spend family time together, etc.).
28) I was never treated, taken medication for, or hospitalized for behavioral health.
SECTION IV: About Family (Answer the following questions about your Parents, Siblings, Grandparents, Aunts/Uncles, and/or Cousins). At least one family member: *
SECTION IV: About Family (Answer the following questions about your Parents, Siblings, Grandparents, Aunts/Uncles, and/or Cousins). At least one family member:
1) Has a history of drug/alcohol abuse.
2) Has a history of Attention Deficit Disorder or Autism.
3) Has experienced sexual abuse or trauma.
4) Has experienced domestic violence/aggression/spousal abuse.
5) Has experienced depression, anxiety, or other behavioral health challenges.
6) Has a history of eating disorder, obesity, anorexia, etc.
7) Has experienced military service-related PTSD (Post Traumatic Stress Disorder).
8) Has a history or self-harm (cutting, suicidal thoughts/attempts, etc.).
9) Has a record of arrest, parole, or probation.
10) Has inflicted serious trauma to me or someone in our family (violence, sexual, etc.).