1. STRENGTHS
QUESTIOMAIRE
Elementary Version 1
General Information
Name____________
Gender____________
Grade Level__________
Career Goals_________
Race____________
Age____________

2. Self
I have self-control. I can think before I act.
[ ] yes
[ ] no
I have goals for when I am older.
[ ] yes
[ ] no
My decisions can change my day and my life.
[ ] yes
[ ] no
Making good choices can make me a better person.
[ ] yes
[ ] no
I have self-esteem and self-confidence.
[ ] yes
[ ] no
I have been taught about and believe in God.
[ ] yes
[ ] no
I read about and listen to music about God.
[ ] yes
[ ] no
God can change how I feel inside.
[ ] yes
[ ] no
I think about God before I act.
[ ] yes
[ ] no
When new or bad things happen, I:
[ ] can get used to it
[ ] deal with it in a new way
[ ] get angry
[ ] get very sad
[ ] am nervous
[ ] ignore them
[ ] feel guilty

3. When I am sad or upset, I don’t want to do any and I want to be alone.
[ ] yes [ ] no
When new or bad things happen, I:
[ ] can get used to it
[ ] deal with it in a new way
[ ] get angry
[ ] get very sad
[ ] am nervous
[ ] ignore them
[ ] feel guilty
When I am sad or upset, I don’t want to do any and I want to be alone.
[ ] yes [ ] no
When good things happen, I:
[ ] Make the most out of the day
[ ] Feel I earned some enjoyment
[ ] Feel unworthy
[ ] Become anxious of what’s next
[ ] Avoid becoming too excited
Family
My family is a team; we:
[ ] help each other at home and with school
[ ] can share our opinion
[ ] feel everyone’s opinion is important and useful
All the
time
Most of
the time
Some of
the time
Occasionally Never
My family is a solid,
supportive unit.
○ ○ ○ ○ ○
I can be honest with my
parents or guardian.
○ ○ ○ ○ ○

4. I believe my parents or
guardian is honest with
me.
○ ○ ○ ○ ○
My parents or guardian
set a good example for
me.
○ ○ ○ ○ ○
All the
time
Most of
the time
Some of
the time
Occasionally Never
I get help and positivity
from many different
family members.
○ ○ ○ ○ ○
My family shares and
communicates a lot.
○ ○ ○ ○ ○
I learn a lot about my
family from my parents
or guardian.
○ ○ ○ ○ ○
My family is close and
trusts each other.
○ ○ ○ ○ ○
I have a positive
relationship with my
mother
○ ○ ○ ○ ○
I have a positive
relationship with my
father
○ ○ ○ ○ ○
Building Hope Community Life Center
All the
time
Most of
the time
Some of
the time
Occasionally Never
I can get help from
BHCLC.
○ ○ ○ ○ ○

5. BHCLC teaches me
about:
○ ○ ○ ○ ○
My Race ○ ○ ○ ○ ○
Education ○ ○ ○ ○ ○
God ○ ○ ○ ○ ○
I feel safe at Building
Hope.
○ ○ ○ ○ ○
Building Hope has helped
me grow in school and
made me closer to God.
○ ○ ○ ○ ○
All the
time
Most of
the time
Some of
the time
Occasionally Never
BHCLC gives me access
to:
Helpful adults. ○ ○ ○ ○ ○
New friends. ○ ○ ○ ○ ○
Chances to learn about
God.
○ ○ ○ ○ ○
A safe place after school. ○ ○ ○ ○ ○
Help with school work. ○ ○ ○ ○ ○
New, fun things. ○ ○ ○ ○ ○