LOCAL INTAKE ASSESSMENT - Section 17 - Lifestyle

Local Name

First Name

Last Name

Manages Free Time Effectively

rate on a scale from 1-10

Religious Practices If Any

Identifying and Maintaining Healthy Friendships

rate on a scale from 1-10

Comments

Able to Maintain Safety Online

rate on a scale from 1-10

Controls spending

rate on a scale from 1-10

Can identify and set future goals

rate on a scale from 1-10

Initiates friendships and social interactions

rate on a scale from 1-10

Understands personal boundaries

rate on a scale from 1-10

Problems solves/stratagizes ways to seek assistance

rate on a scale from 1-10

Understands and remembers emergency protocols

rate on a scale from 1-10

Understands appropriate points of contact for various situations

rate on a scale from 1-10

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