Youth Schema Questionnaire Form
Please complete the Youth Schema Questionnaire Form to share your perspectives and experiences. Your responses will help us better understand youth schemas in a supportive and confidential manner.
Full Name
*
First Name
Last Name
Age
*
How strongly do you agree with the following statement: "I feel accepted by my peers."
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
How often do you feel confident in expressing your opinions?
*
Always
Often
Sometimes
Rarely
Never
I believe I can trust others easily.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
When facing challenges, I feel capable of handling them on my own.
*
Always
Often
Sometimes
Rarely
Never
I feel like I belong in my school or community.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Please describe a time when you overcame a challenge.
What is one personal strength you are proud of?
Is there anything else you would like to share about yourself?
Submit
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