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1. How satisfied are you with the current rules and regulations in the group home?

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2. Which areas of behavior do you think you have improved in? (Select all that apply)

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3. Can you describe any specific actions you have taken to improve your behavior?

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4. How often do you follow the group home's rules and guidelines?

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5. What additional rights or privileges would you like to earn in the future?

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6. What steps do you think you can take to earn these additional rights or privileges?

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7. How supported do you feel by the staff in improving your behavior?

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8. Do you have any suggestions for the staff on how they can better support you?

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9. Please provide your name (optional)

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