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* 1. Fear can play a significant role in our lives by keeping us from taking positive risks and engaging in activities that would help us grow. Identify what holds you back by completing the following sentence. Check all that apply.

I am held back from taking positive risks that would help me grow by fear of:

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* 2. If you said "Other" in response to the prompt above, please define it here..

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* 3. How often does fear of some kind hold you back from doing something that you know would be a good ting to do?

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* 4. Rank order the following according to their importance in helping you to overcome your fears?

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* 5. If you included "Other" in response to the prompt above, please define it here.

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* 6. How interested are you in increasing your capacity to face fears and take positive risks that will help you grow?

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* 7. Describe a recent time when you faced a fear and took a positive risk. What gave you the courage to do so? Responses to this prompt will be summarized but not reported directly.

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* 8. What is your grade?

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* 9. Thank you for taking the survey. If you have any comments to add on this subject, please do so here.

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