Instructions:  Please honestly answer the questions below.  There are no right or wrong answers.
Your responses will be kept private.

Socio-Emotional Resilience Assessment

1. I get easily upset when people insult me or say mean things to me.

2. If someone pushes me, and it doesn't hurt, I can easily ignore it.

3. When someone is being mean to mea and my feelings are hurt, I blame them for hurting me.

4. I laugh and enjoy when someone makes a joke about me.

5. I need people to help me if I'm not getting along with others.

6. When people leave me out from a group or party, I stay upset for a long time.

7. When someone is being mean to me, I don't know how to respond to them.

8. When someone is being mean to me, I know how to protect my feelings from getting hurt.

9. When people tell me that something is wrong with me, I get upset and want them to stop.

10. It really bothers me when kids say bad things about me behind my back.

11. How much is mean behavior effecting your daily life?

12. When someone is mean and tries to hurt my feelings, I usually... (check the two that apply most often)

13. If you are 13 or older, may we share your answers with your parents/guardians?

14. What you share with Jeff will be kept confidential (private) unless someone is in danger. If someone is in danger, Jeff may need to tell your parents and other adults in order to keep people safe.

15. Are you safe right now?