RVM Youth Survey - March 2021
Please rate how strongly you agree with each statement about yourself on a scale from 1 to 10: if you strongly disagree with the statement, select 1; if you are neutral about a statement, select 5, and if you strongly agree, select 10.  You may use any number on the scale to rate yourself.
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Birthday *
MM
/
DD
/
YYYY
Grade *
School *
I believe in myself. *
Strongly Disagree
Strongly Agree
I like to learn new things. *
Strongly Disagree
Strongly Agree
I like to help others. *
Strongly Disagree
Strongly Agree
My Family sees me for who I am. *
Strongly Disagree
Strongly Agree
My family listens to me. *
Strongly Disagree
Strongly Agree
My friends care about me. *
Strongly Disagree
Strongly Agree
It is important to do my best at school. *
Strongly Disagree
Strongly Agree
When I have a problem, I can find a positive answer to the problem. *
Strongly Disagree
Strongly Agree
I can get along with others who are different from me. *
Strongly Disagree
Strongly Agree
I have a trusted adult I can go to for help. *
Strongly Disagree
Strongly Agree
I like to help out at home. *
Strongly Disagree
Strongly Agree
When I am upset... (fill in the blank) *
In my free time, I... (fill in the blank) *
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