Destiny Defined  Pre-Program Questionnaire
In order to help us gauge the effectiveness of our program, we would appreciate it if you would provide answers to the questions below. You will fill out a corresponding post-program questionnaire after the last session.
Sign in to Google to save your progress. Learn more
Student First Name *
Student Last Name *
How confident are you that you have a clear plan of action locked in for the last two years of high school that will allow you to prepare for what lies ahead? *
not at all confident
extremely confident
How certain are you that you have a good sense of who you are and what colleges and career paths would bring you joy and a sense of purpose? *
very uncertain
very certain
How sure are you that you are able to keep mistakes in perspective without being too hard on yourself and without overreacting? *
quite unsure
quite sure
How well have you learned various stress-reduction strategies and put them into practice?   *
not very effectively
very effectively
How confident are you that you are able to keep from being swayed by outside influences (parents, peers, social media, TV/movies, etc.) when it comes to who you are and what you want?   *
not at all confident
extremely confident
How often do you consciously think about how grateful you are for the life you have even when things aren’t necessarily going well? *
hardly ever
almost all the time
How confident are you that you can change the world for the better in some meaningful way?       *
least confident
most confident
How capable do you feel of using multiple strategies to persevere and continue pushing forward even when you suffer setbacks or receive negative criticism? *
not at all capable
extremely capable
How effectively do you manage your time so that you stay on top of your responsibilities without creating any unnecessary stress by getting caught up in distractions or procrastinating?     *
not effectively at all
extremely effectively
What made you decide to join the Destiny Defined pilot program? *
What do you hope to gain from the program? *
Is there anything else you would like us to be aware of related to your participation in the program?
For one of our icebreakers, we would appreciate it if you would provide 3 of the most unusual, distinctive facts about yourself that you can think of. Really dig for unique things that no one else in the group would share in common with you. So, "I have 2 brothers and 2 sisters" is a nice fact, but that's not guaranteed to set you apart. Now, if you have 6 brothers and 5 sisters, THAT would work as one of your facts.  Please format your answer like this:  1) I got stuck at the top of a rollercoaster at Cedar Point   2) I shook hands with President Obama  3) I drove a car when I was six years old    :) *
Please list any medical conditions that we may need to know about.
Please list any allergies we should be aware of (bee stings, certain kinds of foods, etc.).
We will be providing lunch both Sundays. Will you need the food to be prepared according to kosher guidelines? *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms