Teen Pre-Internship Survey
Instructions: This survey is to be completed by the teen, NOT by their parent/guardian. Choose whichever answer seems best for how you’ve felt in the last seven days.
Date
*
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Rosenberg Self-Esteem Scale
1. On the whole, I am satisfied with myself.
*
Strongly Agree
Agree
Disagree
Strongly Disagree
2. At times I think I am no good at all.
*
Strongly Agree
Agree
Disagree
Strongly Disagree
3. I feel that I have a number of good qualities.
*
Strongly Agree
Agree
Disagree
Strongly Disagree
4. I am able to do things as well as most other people.
*
Strongly Agree
Agree
Disagree
Strongly Disagree
5. I feel I do not have much to be proud of.
*
Strongly Agree
Agree
Disagree
Strongly Disagree
6. I certainly feel useless at times.
*
Strongly Agree
Agree
Disagree
Strongly Disagree
7. I feel that I'm a person of worth, at least on an equal plane with others.
*
Strongly Agree
Agree
Disagree
Strongly Disagree
8. I wish I could have more respect for myself.
*
Strongly Agree
Agree
Disagree
Strongly Disagree
9. All in all, I am inclined to feel that I am a failure
*
Strongly Agree
Agree
Disagree
Strongly Disagree
10. I take a positive attitude toward myself.
*
Strongly Agree
Agree
Disagree
Strongly Disagree
PROMIS SF 8a- Anxiety
I felt fearful.
*
never
rarely
sometimes
usually
always
I found it hard to focus on anything other than my anxiety.
*
never
rarely
sometimes
usually
always
My worries overwhelm me.
*
never
rarely
sometimes
usually
always
I felt uneasy.
*
never
rarely
sometimes
usually
always
I felt nervous.
*
never
rarely
sometimes
usually
always
I felt like I needed help for my anxiety.
*
never
rarely
sometimes
usually
always
I felt anxious.
*
never
rarely
sometimes
usually
always
I felt tense
*
never
rarely
sometimes
usually
always
PROMIS SF 4a- Meaning and Purpose
I feel hopeful about my future.
*
not at all
a little bit
somewhat
quite a bit
very much
I can reach my goals in life.
*
not at all
a little bit
somewhat
quite a bit
very much
My life is filled with meaning
*
not at all
a little bit
somewhat
quite a bit
very much
My life has purpose
*
not at all
a little bit
somewhat
quite a bit
very much
PROMIS SF 8a- Positive Affect
I felt happy.
*
never
rarely
sometimes
usually
always
I felt great.
*
never
rarely
sometimes
usually
always
I felt cheerful.
*
never
rarely
sometimes
usually
always
I felt joyful.
*
never
rarely
sometimes
usually
always
I was in a good mood.
*
never
rarely
sometimes
usually
always
I felt refreshed.
*
never
rarely
sometimes
usually
always
I felt calm.
*
never
rarely
sometimes
usually
always
I felt peaceful
*
never
rarely
sometimes
usually
always
Submit
Should be Empty: