| 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. |