JKM Pre-Assessment Outcomes
Please fill out the entire form with your honest answers.
What is your first and last name? *
I am confident in my scholastic abilities. *
Please rate how strongly you agree or disagree with the following statements. In answering each question, uses a range from (1)strongly disagrees to (7) strongly agree.
Strongly Disagree
Strongly Agree
I do well in school. *
Please rate how strongly you agree or disagree with the following statements. In answering each question, uses a range from (1)strongly disagrees to (7) strongly agree.
Strongly Disagree
Strongly Agree
I learn new concepts quickly. *
Please rate how strongly you agree or disagree with the following statements. In answering each question, uses a range from (1)strongly disagrees to (7) strongly agree.
Strongly Disagree
Strongly Agree
I am comfortable with sharing ideas. *
Please rate how strongly you agree or disagree with the following statements. In answering each question, uses a range from (1)strongly disagrees to (7) strongly agree.
Strongly Disagree
Strongly Agree
I am confident in my ability to succeed in school. *
Please rate how strongly you agree or disagree with the following statements. In answering each question, uses a range from (1)strongly disagrees to (7) strongly agree.
Strongly Disagree
Strongly Agree
On the whole, I am satisfied with myself. *
At times I think I am no good at all. *
I feel that I have a number of good qualities. *
I am able to do things as well as most other people. *
I feel I do not have much to be proud of. *
I certainly feel useless at times. *
I feel that I am a person of worth, at least on an equal plane with others. *
I wish I could have more respect for myself. *
All in all, I am inclined to feel like I am a failure. *
I take a positive attitude toward myself. *
You can say no to activities that you think are wrong. *
You can identify the positive and negative consequences of a behavior. *
You try to make sure that everyone in a group is treated fairly. *
You think you should work to get something if you really want it. *
You make decisions to help achieve your goals. *
You know how to organize your time to get all your work done. *
Sometimes I have to physically fight to get what I want. *
Choose the answer that shows how much you agree with the following statements. YES! Means you agree a lot, yes means you agree and no means you disagree, and NO! Means you disagree a lot.
I get mad easily. *
Choose the answer that shows how much you agree with the following statements. YES! Means you agree a lot, yes means you agree and no means you disagree, and NO! Means you disagree a lot.
I do whatever I feel like doing. *
Choose the answer that shows how much you agree with the following statements. YES! Means you agree a lot, yes means you agree and no means you disagree, and NO! Means you disagree a lot.
When I am mad, I yell at people. *
Choose the answer that shows how much you agree with the following statements. YES! Means you agree a lot, yes means you agree and no means you disagree, and NO! Means you disagree a lot.
Sometimes I break things on purpose. *
Choose the answer that shows how much you agree with the following statements. YES! Means you agree a lot, yes means you agree and no means you disagree, and NO! Means you disagree a lot.
If I feel like it, I hit people. *
Choose the answer that shows how much you agree with the following statements. YES! Means you agree a lot, yes means you agree and no means you disagree, and NO! Means you disagree a lot.
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