40 Developmental Assets Survey 16-17
Please read each question carefully. Click "true" or "false" for each question.
Last Name
Your answer
First Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Academy Teacher
Your answer
Grade
Gender
1. I receive lots of love and support from my family...
2. My parent(s) and I communicate positively, and I am willing to go to my parent (s) for advice and counsel...
3. I receive support from three or more nonparent adults...
4. I experience caring neighbors...
5. My school provides a caring, encouraging environment...
6. My parent(s) are actively involved in helping me succeed in school...
7. I believe that adults in my community value youth...
8. I believe that young people are given useful roles in my community...
9. I serve in my community for one hour or more per week...
10. I feel safe at home, at school, and in the neighborhood...
11. My family has clear rules and consequences, and monitors my wherabouts...
12. My school provides clear rules and consequences...
13. My neighbors take responsibility for monitoring young people's behavior...
14. Parent(s) and other adults model positive, responsible behavior...
15. My best friends model responsible behavior...
16. Both my parent(s) and my teachers encourage me to do well...
17. I spend three hours or more per week in lessons or practice in music, theater, or other arts...
18. I spend three hours or more per week in sports, clubs, organizations at school, and/or in community organizations...
19. I spend one or more hours per week in activities in a religious institution...
20. I go out with friends "with nothing special to do," two or fewer nights per week...
21. I am motivated to do well in school...
22. I am actively engaged in learning...
23. I do at least one hour of homework every school day...
24. I care about my school...
25. I read for pleasure three or more hours per week...
26. I place a high value on helping other people...
27. I place a high value on promoting equality and reducing hunger and poverty...
28. I act on my convictions and stand up for my beliefs...
29. I tell the truth even when it is not easy...
30. I accept and take personal responsibility...
31. I believe it is important not to be sexually active or to use alcohol or other drugs...
32. I know how to plan ahead and make choices...
33. I have empathy, sensitivity, and friendship skills...
34. I have knowledge of and comfort with people of different cultural/racial/ethnic backgrounds...
35. I can resist negative peer pressure and dangerous situations...
36. I seek to resolve conflict nonviolently...
37. I feel I have control over things that happen to me...
38. I have a high self-esteem...
39. I believe my life has a purpose...
40. I am optimistic about my personal future...
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms