Asset Checklist



         

       

Name


A red asterisk (*) indicates required questions.


  1. Please rate each of the following items on the scale of 1 to 5.*

            1 2 3 4 5      
      I receive high levels of love and support from family members. Strongly agree  Strongly disagree  
      I can go to my parents or guardian for advice aned support and have frequent in-depth conversations with them. Strongly agree  Strongly disagree  
      I know some nonparent adults I can go to for advice and support. Strongly agree  Strongly disagree  
      My neighbors encourage and support me. Strongly agree  Strongly disagree  
      My school provides a caring, encouraging environment. Strongly agree  Strongly disagree  
      My parent or guardian help me succeed in school. Strongly agree  Strongly disagree  
      I feel valued by adults in my community. Strongly agree  Strongly disagree  
      I am given useful roles in my community. Strongly agree  Strongly disagree  
      I serve in the community one hour or more wach week. Strongly agree  Strongly disagree  
      I feel safe at home, at school, and in the neighborhood. Strongly agree  Strongly disagree  
      My family sets standards for appropriate conduct and monitors my whereabouts. Strongly agree  Strongly disagree  
      My school has clead rules and consequences for behavior. Strongly agree  Strongly disagree  
      Neighbors take responsibility for monitoring by behavior. Strongly agree  Strongly disagree  
      Parents and other adults model positive responsible behavior.  Strongly agree  Strongly disagree  
      My best friends mdoel responsible beahvior.My parent/agguardian and teahcers encourage me to do well. Strongly agree  Strongly disagree  
      I spend three hours or more each week in lessons or practice in music, theater or other arts. Strongly agree  Strongly disagree  
      I spend three or more hours each week in school or community sports, clbus or organizations. Strongly agree  Strongly disagree  
      I spend one hour or more each week in religious services participating in spritiual activities. Strongly agree  Strongly disagree  
      I go out with friends with nothing special to do two or fewer nights each week. Strongly agree  Strongly disagree  





Communication Technology Teacher
Loveland High School
Loveland, OH