Participant Self-Assessment- This Is My Life Book Club
This initial self assessment is optional, but very important to help you identify and focus on a particular area of life in which you'd like to improve.
Please do not include any confidential, sensitive, or financial information.
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Date
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1. My Name
2. How satisfied am I about how my school/work/personal life is going for me? Why?
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3. In which area of my life would I like to improve?
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4. In the area of life selected in question 3, what would I most like to improve?
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5. What do I like best about my area of life selected to improve (education/work/personal)? 
6. What do I like least about my area of life selected to improve (education/work/personal)? 
7. What should I do to better help myself?
8. What should my educators/employer/others do to better help me?
9. In addition to what I shared above, what else would I like to learn or do?
10. In addition to what I shared above, I'd like to share this additional information.
11. What would I do if I had ten million dollars?
A copy of your responses will be emailed to the address you provided.
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