Youth Survey - Post-Program

How much do you think your relationships will change because of this course?

a)       A great deal

b)      A lot

c)       A moderate amount

d)      A little

e)      None at all

How much do you feel connected to U.S. values?

f)        A great deal

g)       A lot

h)      Somewhat

i)        A little

j)        None at all

How much do you feel connected to U.S. history?

a)       A great deal

b)      A lot

c)       Somewhat

d)      A little

e)      None at all

How much do you feel connected to U.S. lifestyle?

a)       A great deal

b)      A lot

c)       Somewhat

d)      A little

e)      None at all

Strongly agree

Agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Disagree

Strongly disagree

Relationships are either compatible or they are not

7

6

5

4

3

2

1

A good relationship means finding a compatible partner right from the start

7

6

5

4

3

2

1

Relationship partners are either destined to get along or they are not

7

6

5

4

3

2

1

Relationships that do not start off well will fail

7

6

5

4

3

2

1

The ideal relationship grows slowly over time

7

6

5

4

3

2

1

Challenges and hard things in a relationship can make love even stronger

7

6

5

4

3

2

1

A good relationship means learning to solve conflicts with a partner

7

6

5

4

3

2

1

A good relationship grows out of hard work and fixing problems

7

6

5

4

3

2

1

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

I am a happy person

5

4

3

2

1

I am satisfied with my life

5

4

3

2

1

I am satisfied with my relationship with others

5

4

3

2

1

I feel loved and wanted

5

4

3

2

1

I feel my relationships are full and complete

5

4

3

2

1

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

I believe I will be able to deal well with conflicts in my relationships.

5

4

3

2

1

I feel good about my ability to make a romantic relationship last.

5

4

3

2

1

I am very confident when I think of having a stable, long term relationship.

5

4

3

2

1

I have the skills needed for a lasting stable romantic relationship.

5

4

3

2

1

I am able to recognize early on the warning signs in a bad relationship.

5

4

3

2

1

I weigh the pros and cons before I take the next step in the relationship

5

4

3

2

1

It is important to make thoughtful decisions about each minor step in romantic relationships

5

4

3

2

1

Considering the pros and cons of each major step in a romantic relationship destroys its chemistry.

5

4

3

2

1

I know what to do when I see the warning signs in a bad relationship.

5

4

3

2

1

I am quickly able to see warning signs in a romantic relationship

5

4

3

2

1

It is important to me to discuss with my boyfriend/girlfriend each major step we take in the relationship

5

4

3

2

1

It is better to "go with the flow" than think carefully about each major step in a romantic relationship

5

4

3

2

1

All of the Time

Most of the time

More than half the time

less than half the time

some of the time

At no time

I have felt cheerful and in good spirits

5

4

3

2

1

0

I have felt calm and relaxed

5

4

3

2

1

0

I have felt active and vigorous

5

4

3

2

1

0

I woke up feeling refreshed and rested

5

4

3

2

1

0

My daily life has been filled with things that interest me.

5

4

3

2

1

0

1 = Never or hardly at all

2 = Seldom or not too much

3 = Sometimes or somewhat

4 = often or very much

5 = ALWAYS or EXTREMELY much

Best Friend

Girl/boy

Friend

Parent/

Guardian

How often do you tell this person things that you don't want others to know?

How often do you turn to this person for support with personal problems?

How often do you tell this person everything that you are going through?

How often do you depend on this person for help, advice, or sympathy?

How often do you share secrets and private feelings with this person?

When you are feeling down or upset, how often do you depend on this person to cheer things up?

Never

Seldom

Sometimes

Often

Almost Always

. . . lost your temper?

1

2

3

4

5

. . . felt angry?

1

2

3

4

5

. . . yelled at people?

1

2

3

4

5

. . . gotten into fights or arguments?

1

2

3

4

5

Strongly agree

Agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Disagree

Strongly disagree

When I want to do something, my parent(s)* show me how

7

6

5

4

3

2

1

When I want to understand how something works, my parent(s)* explain it to me

7

6

5

4

3

2

1

If I ever have a problem, my parent(s)* help me figure out what to do about it

7

6

5

4

3

2

1

My parent(s)* explain the reasons for our family rules

7

6

5

4

3

2

1

How many romantic relationships (if any) have you had up to this point?

(This includes any that you are in now.)

0

1

2

3

4

5

6

7

8

9

10+

Prefer not to answer

IF YOU ANSWERED “0” or “prefer not to answer” on the above question, YOU ARE DONE. Please do not fill out any of the remaining questions.

Otherwise, please answer just a few more questions about your experience in your current/most recent relationship.

How often did you feel your girl/boyfriend tried to control you?

a)       Never

b)      Seldom

c)       Sometimes

d)      Often

How often did your girl/boyfriend cross your boundaries against your wishes?

a)       Never

b)      Seldom

c)       Sometimes

d)      Often

How often did you feel safe in this relationship?

a)       Never

b)      Seldon

c)       Sometime

d)      Often

Never

Seldom

Sometimes

Often

I did something to make her/him feel jealous.

1

2

3

4

I told her/him that I was partly to blame.

1

2

3

4

I brought up something bad that s/he had done in the past.

1

2

3

4

I said things just to make her/him angry.

1

2

3

4

I gave reasons why I thought s/he was wrong.

1

2

3

4

I agreed that s/he was partly right.

1

2

3

4

I spoke to her/him in a hostile or mean tone of voice.

1

2

3

4

I offered a solution that I thought would make us both happy.

1

2

3

4

I put off talking until we calmed down.

1

2

3

4

I insulted her/him with put-downs.

1

2

3

4

I discussed the issue calmly.

1

2

3

4

I ridiculed or made fun of her/him in front of others.

1

2

3

4

I told her/him how upset I was.

1

2

3

4

I blamed her/him for the problem.

1

2

3

4

I left the room to cool down.

1

2

3

4

I said s/he was hurting my feelings.

1

2

3

4