Dell H. Robinson Middle School Personal Molding EvaluationName:_______________Grade:_______________

1) What builds your character in your life right now? Which friend, family, or personal activities or beliefs?________________________________________________________________________________________________________________________________________________

2) Are there any personal obstacles, setbacks, or people in your life right now that you feel depressed, stressed, or angered about? What are they?________________________________________________________________________________________________________________________________________________

3) Which short and long term goals do you plan on achieving that will boost your future career right now?________________________________________________________________________________________________________________________________________________

4) Do you like your appearance? What do you like about your appearance? What makes you feel good about yourself? What part of yourself would you like to improve? Are you happy with your body shape? What do you think of your overall body image?________________________________________________________________________________________________________________________________________________________________________________________________________________________

5) Do you like school? Why or why not? What are your favorite and least favorite classes? ______________________________________________________________________What is your GPA_______? Who is your favorite teacher_______________________?

6) What area of life do you need help in to increase your self-esteem? List any physical or mental challenges that education could help you over come______________________________________________________________________________________________

7) What programs would help you to become a better student academically or athletically? ____________________________________________________________