Socio-Emotional Resilience Assessment

First Name

Last Name

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

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

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

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

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

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

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

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

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

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

11. How much is mean behavior effecting your daily life? 11. How much is mean behavior effecting your daily life? It doesn't bother me at all It bothers me a little It bothers me a lot It bothers me all of the time

12. When someone is mean and tries to hurt my feelings, I usually... (check the two that apply most often) 12. When someone is mean and tries to hurt my feelings, I usually... (check the two that apply most often) Get upset and do something mean back Get upset and walk/run away Get upset and keep to myself Stay calm and say or do something kind back Stay calm and run/walk away Stay calm and keep to myself

13. If you are 13 or older, may we share your answers with your parents/guardians? 13. If you are 13 or older, may we share your answers with your parents/guardians? Yes, you can No, only share with Jeff

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. 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. I understand and agree

15. Are you safe right now? 15. Are you safe right now? Yes No