| Pre or Post Assessment: | Pre or Post Assessment: |
| Assessment Date: | Assessment Date: |
| Youth Participant Name: | Youth Participant Name: | _____________________________________________________ |
| Program Coodinator: | Matthew S. (YouthWorks-ML2) | Program Coodinator: | Matthew S. (YouthWorks-ML2) |
| Evaluator: | Zena D. (external evaluator) | Evaluator: | Zena D. (external evaluator) |
| Please rate the items from 0 to 3, where 0 is "not at all" and 3 is "all the time". | Please rate the items from 0 to 3, where 0 is "not at all" and 3 is "all the time". |
| # | Item | Rate (0 to 3) | # | Item | Rate (0 to 3) |
| 1. | I have a friendly personality | 1. | I have a friendly personality |
| 2. | I get along with others | 2. | I get along with others |
| 3. | I respect others | 3. | I respect others |
| 4. | I am open-minded | 4. | I am open-minded |
| 5. | I consider the needs of others | 5. | I consider the needs of others |
| 6. | I consider input from all group members | 6. | I consider input from all group members |
| 7. | I can listen effectively | 7. | I can listen effectively |
| 8. | I show a responsible attitude | 8. | I show a responsible attitude |
| 9. | I have a positive self-concept | 9. | I have a positive self-concept |
| 10. | I trust other people | 10. | I trust other people |
| 11. | I am sensitive to others | 11. | I am sensitive to others |
| 12. | I can be flexible | 12. | I can be flexible |
| 13. | I can set goals | 13. | I can set goals |
| 14. | I have good manners | 14. | I have good manners |
| 15. | I recognize the worth of others | 15. | I recognize the worth of others |
| 16. | I can be honest with others | 16. | I can be honest with others |
| 17. | I can express feelings | 17. | I can express feelings |
| 18. | I am open to change | 18. | I am open to change |
| 19. | I can handle mistakes | 19. | I can handle mistakes |
| 20. | I can use information to solve problems | 20. | I can use information to solve problems |
| 21. | I can delegate responsibility | 21. | I can delegate responsibility |
| 22. | I create an atmosphere of acceptance | 22. | I create an atmosphere of acceptance |
| 23. | I can consider alternatives | 23. | I can consider alternatives |
| 24. | I can set priorities | 24. | I can set priorities |
| 25. | I can be tactful | 25. | I can be tactful |
| 26. | I can select alternatives | 26. | I can select alternatives |
| 27. | I can solve problems | 27. | I can solve problems |
| 28. | I use rational thinking | 28. | I use rational thinking |
| 29. | I can clarify my values | 29. | I can clarify my values |
| 30. | I can determine needs | 30. | I can determine needs |
| TOTAL SCORE | 0 | TOTAL SCORE | 0 |
| This tool is based on research by Miller, 1976 and Seevers, et al, 1995 | This tool is based on research by Miller, 1976 and Seevers, et al, 1995 |
| Conceptual Sub-Domain | Numbers of Indicators | Item Numbers | Score | Conceptual Sub-Domain | Numbers of Indicators | Item Numbers | Score |
| Communication Skills | 2 | 3,15 | 0 | Communication Skills | 2 | 3,15 | 0 |
| Decision Making Skills | 5 | 1,4,8,16,19 | 0 | Decision Making Skills | 5 | 1,4,8,16,19 | 0 |
| Skills in Getting Along with Others | 7 | 5,9,17,20,23,25,29 | 0 | Skills in Getting Along with Others | 7 | 5,9,17,20,23,25,29 | 0 |
| Learning Skills | 4 | 6,10,21,27 | 0 | Learning Skills | 4 | 6,10,21,27 | 0 |
| Management Skills | 3 | 7,28,30 | 0 | Management Skills | 3 | 7,28,30 | 0 |
| Skills in Understanding Self | 6 | 2,12,13,22,24,26 | 0 | Skills in Understanding Self | 6 | 2,12,13,22,24,26 | 0 |
| Skills in Working with Groups | 3 | 11,14,18 | 0 | Skills in Working with Groups | 3 | 11,14,18 | 0 |
| Respondents self-score each item on a Lickert Scale of 0 to 3 (3 being the highest). Minimum score 0, a maximum score 90; 0 to 30 = no to slight leadership life skills development, 31 to 60 = moderate development, 61 to 90 = high development. | Respondents self-score each item on a Lickert Scale of 0 to 3 (3 being the highest). Minimum score 0, a maximum score 90; 0 to 30 = no to slight leadership life skills development, 31 to 60 = moderate development, 61 to 90 = high development. |