Each question has a key word that will result in a score with a denominator of 4.
Each catagory has three questions that will result in a total score that will be an indicator of your wellness.
First Name : Number

 Physical:Sleep = 0 Activity = 0 Nutrition = 0 Physcial Score = 0 /12
 Emotional:Help = 0 Exploration = 0 Stressors = 0 Emotional Score = 0 /12
 Financial:Goals = 0 Means = 0 Budget = 0 Financial Score = 0 /12
 Environment:Community = 0 Risks = 0 Ecology = 0 Environmental Score = 0 /12
 Spiritual:Wellbeing = 0 Values = 0 Direction = 0 Career and Academic Score = 0 /12
 Career and Academic: Planning = 0 Work = 0 Challenges = 0 Career and Academic Score = 0 /12
 Social & Cultural:Relationships = Groups = 0 Culture = 0 Social & Culture Score = 0 /12
.phy{color: #FF0000;} .soc {color: #00CC33;} .car {color:#FF00CC;} .spi {color: #660099;} .env {color: 006600;} .fin {color: #FF8C00;} .emo {color: #0000FF;} First Name's Wellness
First Name Unique Number

Physical
1.1 I get adequate sleep and awake feeling refreshed.
Never Sometimes Often Most of the time All the time
1.2 I get at least 30 minutes of moderate physical activity each day (Examples: Brisk walking, cycling, running or aerobics.)
Never Sometimes Often Most of the time All the time
1.3 I eat regular, nutritious meals that give me the energy I need to stay active and get through the day.
Never Sometimes Often Most of the time All the time

Emotional
2.1 I am able to ask for/seek out help when I need it from friends, family or professionals.
Never Sometimes Often Most of the time All the time
2.2 I value self-exploration and self-improvement.
Never Sometimes Often Most of the time All the time
2.3 I am able to recognize and manage the different stressors in my life.
Never Sometimes Often Most of the time All the time

Financial
3.1 I have both short term and long term financial goals.
Never Sometimes Often Most of the time All the time
3.2 I live within my means (Examnple: I have the money I need and don’t borrow from my friends or family).
Never Sometimes Often Most of the time All the time
3.3 I budget my spending each month and plan for upcoming big expenses.
Never Sometimes Often Most of the time All the time

Environment
4.1 I care for and respect the environment and my community.
Never Sometimes Often Most of the time All the time
4.2 I am aware of risks within my environment an make adjustments to my lifestyle accordingly (Example: Personal safety at home and at school).
Never Sometimes Often Most of the time All the time
4.3 I try to live an eco-friendly lifestyle (Example: Drive less, turn off lights, and recycle).
Never Sometimes Often Most of the time All the time

Spiritual
5.1 I feel an overall sense of peace and wellbeing in my life.
Never Sometimes Often Most of the time All the time
5.2 I understand my own values and beliefs, and respect the values, ethics and beliefs of others.
Never Sometimes Often Most of the time All the time
5.3 I believe my life to have direction and meaning.
Never Sometimes Often Most of the time All the time

Career and Academic
6.1 I have a plan for a career/work after high school.
Never Sometimes Often Most of the time All the time
6.2 I am satisfied with my work/school performance.
Never Sometimes Often Most of the time All the time
6.3 I seek out new challenges and academic/career goals.
Never Sometimes Often Most of the time All the time

Social & Cultural
7.1 I'm able to find the time to maintain healthy relationships with my loved ones.
Never Sometimes Often Most of the time All the time
7.2 I feel a sense of belonging to a group or a community.
Never Sometimes Often Most of the time All the time
7.3 I respect others and their cultural identities.
Never Sometimes Often Most of the time All the time


Developed by Rebecca Schlegel and Craig Coleman - Pasco High School - 1/22/14 - La vita e bella