Complete this self-assessment form.
Evaluation of your Current Situation

Select the number that best reflects your current feelings about the
areas of your life listed on the left hand side of the page.

  Very
Negative		 Somewhat
Negative		  
Neutral		 Somewhat
Positive		 Very
Positive
Your Country: 1 2 3 4 5 6 7 8 9 10
Your Marriage: 1 2 3 4 5 6 7 8 9 10
Your Work: 1 2 3 4 5 6 7 8 9 10
Your Parenting: 1 2 3 4 5 6 7 8 9 10
Your Play: 1 2 3 4 5 6 7 8 9 10
Your Friends: 1 2 3 4 5 6 7 8 9 10
Your Mentor: 1 2 3 4 5 6 7 8 9 10
Your Past: 1 2 3 4 5 6 7 8 9 10
Your Present: 1 2 3 4 5 6 7 8 9 10
Your Future: 1 2 3 4 5 6 7 8 9 10
Your Character: 1 2 3 4 5 6 7 8 9 10
Your Purpose: 1 2 3 4 5 6 7 8 9 10
  Very
Negative		 Somewhat
Negative		  
Neutral		 Somewhat
Positive		 Very
Positive
 
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