Self Regulation Small Group Curriculum:

Pre-Assessment Survey

1. On a normal day I feel….

2. Something that is difficult for me is…. (check the ones that apply to you)

____ staying on task in class and participating

____ feeling silly or over-energized during class

____ feeling tired at school

____ solving conflicts with my friends or classmates

3. What do I think this group is about?

4. What is something that I want to learn in the group?

5. On a bad day I feel….

6. Are you looking forward to participating in this group?

 Self Regulation Small Group Curriculum:
Pre-Assessment Survey

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