First Name *

Year Level *

School Name *

If your school is missing from the above list, add it here

Term / Year *

Term 4, 2024

Group Mentor Name *

1. If I need help, I know how to ask for it. *

A. I always know how to ask for help.

B. I usually know how to ask for help.

C. I sometimes know how to ask for help.

D. I almost never know how to ask for help.

2. I know ways to calm myself down when I get angry or upset. *

A. I always know how to calm myself down.

B. I usually know how to calm myself down.

C. I sometimes know how to calm myself down.

D. I almost never know how to calm myself down.

3. Do you try to think about how other people feel when you say or do something? *

A. I consistently try to think about how others feel.

B. I usually try to think about how others feel.

C. I sometimes try to think about how others feel.

D. I almost never try to think about how others feel

4. When I get distracted, I can get back to my task... *

A. I consistently get back on task

B. I usually get back on task

C. I sometimes get back on task, but it can be challenging.

D. I almost never get back on task.