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* 1. Student Name

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* 3. At which school did you implement SAP?

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* 5. Please rate the following from your observations on this student-

  A positive effect No effect Unsure of effect
1. ability to find new and positive ways to deal with problems
2. feelings of self worth
3. ability to cope in stressful situations
4. ability to communicate and express feelings in a positive way with others
5. ability to make or explore supportive friendships
6. ability to help friends who need assistance
7. getting along with other students
8. school attendance
9. general attitude towards school
10. overall school work
11. ability to focus on task at hand in the classroom
12. response to your directions
13. exercising self-discipline
14. your relationship with the student
15. ability to work with others

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* 6. Other observations on how the group has helped your student?

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* 7. Other ways we could be helpful?

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* 8. Would you support this student attending another group?

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* 9. Are there other students whom you would like to refer who may benefit from the group?

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