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1. What is you name?

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2. Are you with Learn Harrow or the Xcite project?

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3. What age group are you?

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4. Are you doing a course, work placement or getting employment support?

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5. What is the name of your Course, your work placement or advisor?

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6. On the whole, I am satisfied with myself

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7. At times, I think I am no good at all

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8. I feel that I have a number of good qualities

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9. I am able to do things as well as most other people

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10. I feel I do not have much to be proud of

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11. I certainly feel useless at times

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12. I feel that I’m a person of worth, at least on an equal plane with others

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13. I wish I could have more respect for myself

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14. All in all, I am inclined to feel that I am a failure

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15. I take a positive attitude toward myself

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