Lesson 1: Resolutions
Handout 1

Personal Self-Discipline Survey

 

Choose the extent to which you agree or disagree with each statement by rating your responses on this 5-1 scale:
 
Strongly Agree          Agree                   Not Sure               Disagree            Strongly Disagree
5                              4                            3                               2                               1
 
                                                                                                                                                                                                                                                                                                                Rating
 
1.                  I keep promises I make to others.
2.                  My room is organized enough for me to find what I need.
3.                  I complete school assignments on time.
4.                  I am able to keep a secret when asked to do so.
5.                  I decide what I want to spend my money on and am able to save toward
that goal.
6.                  I am able to stay “cool headed” when something angers or upsets me.
7.                  I do not break school rules.
8.                  People can depend on me to do what I say I will do.
9.                  If friends want me to do something I know I shouldn’t do, I am able to walk
away.
10.             I shower/bathe on a regular basis.
11.             I eat healthy foods and get regular exercise.
12.             I keep the promises I make to myself.
13.             I could give up my cell phone, videos games, junk food, and/or T.V. for a week.
14.             I set a expectations for my day and can stick to them.
15.             I choose to attend school and to arrive on-time everyday.
16.             I do not cheat, even when the opportunity presents itself.
17.             I always do my personal best.
18.             I can start a challenging task and am able to stay focused on it until the task is completed.
19.             I don’t need to be reminded to do chores or homework.
20.             I usually don’t whine or complain.
 
Total Rating Points                          ___________
Total Points divided by 20 = Personal Self-Discipline Score                       ___________