Self Report Survey
  Fill in option for each item that best applies to you and submit your email at the end of the           survey for feedback.


















































  Fill in option for each item that best 
  applies to you and submit your email for feedback.

  




Rarely - 0ptsSometimes -1ptsOften - 2pts I wake up angry
Rarely - 0ptsSometimes -1ptsOften - 2pts I feel like a loser
Rarely - 0ptsSometimes -1ptsOften - 2pts I show my anger with aggressive acts
Rarely - 0ptsSometimes -1ptsOften - 2pts People say I don't listen
Rarely - 0ptsSometimes -1ptsOften - 2pts I wish I could manage my worries better
Rarely - 0ptsSometimes -1ptsOften - 2pts I plan to get people back
Rarely - 0ptsSometimes -1ptsOften - 2pts People say I'm an angry person
Rarely - 0ptsSometimes -1ptsOften - 2pts People say I'm careless
Rarely - 0ptsSometimes -1ptsOften - 2pts I wake up nervous
Rarely - 0ptsSometimes -1ptsOften- 2pts I feel like I can't concentrate b/c I'm worried
Rarely - 0ptsSometimes -1ptsOften - 2pts I wish I could manage my anger better
Rarely - 0ptsSometimes -1ptsOften - 2pts I worry
Rarely - 0ptsSometimes -1ptsOften - 2pts I wish I could pay attention better
Rarely - 0ptsSometimes -1ptsOften - 2pts I wake up feeling sad or down
Rarely - 0ptsSometimes -1pts Often - 2pts When I feel down I hurt someone or myself
Rarely - 0ptsSometimes -1ptsOften - 2pts I feel drained
Rarely - 0ptsSometimes -1ptsOften - 2pts I do what others tell me to do
Rarely - 0ptsSometimes -1ptsOften - 2pts I wish I could control what I do better
Rarely - 0ptsSometimes -1ptsOften - 2pts I find it hard to wait my turn
Rarely - 0ptsSometimes -1ptsOften - 2pts I feel tense
Rarely - 0ptsSometimes -1ptsOften - 2pts I wish I could manage my sad feelings better
Rarely - 0ptsSometimes -1ptsOften - 2pts My actions are caused by what others do
Rarely - 0ptsSometimes -1ptsOften - 2pts I have a hard time making decisions
Rarely - 0ptsSometimes -1ptsOften - 2pts People say I rush
Rarely - 0ptsSometimes -1ptsOften-2pts I believe what I do now will not change tomorrow