Youth Skills Questionnaire
Please take a moment to fill out this short, 4-question survey
Name
First Name
Last Name
Date
1. Please rate yourself on the following skills. Do you:
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Take initiative and responsibility for own goals
1
2
3
4
5
Recognize own strengths
6
7
8
9
10
Acknowledge own challenges and barriers
11
12
13
14
15
Work through challenges or setbacks
16
17
18
19
20
Problem-solve when something doesn't go according to plan
21
22
23
24
25
Recognize the risks and benefits of your own actions
26
27
28
29
30
Ask for help appropriately if needed
31
32
33
34
35
Respect boundaries, rules, and/or agreements
36
37
38
39
40
Say 'no' if friends or adults ask you to do something that makes you feel uncomfortable or that you feel is wrong
41
42
43
44
45
2. What are other skills you feel you have already or would like to work towards?
3. Do you believe that how you act can affect your outcomes?
Never
Sometimes
Often
Always
Please Explain.
4. On a range, what impacts your behavior response the most- you or others. (1 being totally you, 5 being equal between you and others and 10 being totally the other person.)
1
2
3
4
5
6
7
8
9
10
My Actions
Others' Actions
1 is My Actions, 10 is Others' Actions
Submit
Should be Empty: