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Please select the response that best describes how you feel about each statement: This is to gather a baseline for your participation in the Wellness Center. How do you rate yourself currently?

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* 1. Date

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* 2. Member Number

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* 3. I participate more in social activities.

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* 4. I am better able to cope with crisis.

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* 5. I am better able to manage relationships.

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* 6. I do better in social situations.

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* 7. I can better manage my mental health symptoms.

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* 8. I do things that are more meaningful to me.

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* 9. I am more capable of meeting my needs.

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* 10. I have people with whom I can do enjoyable things.

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* 11. I am more able to develop healthy relationships.

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* 12. I am better able to handle things when they go wrong.

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* 13. I feel I belong in the community.

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* 14. Please explain how or what groups/services at the Wellness Center affected your responses to question #1 - #11.

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* 15. I am more interested in finding employment.

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* 16. I am more confident in my employment skills.

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* 17. I am more certain about my employment goals.

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* 18. I have gained employment.

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* 19. I am more interested in furthering my education.

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* 20. I have learned a new skill or hobby (i.e. cooking, computer, leadership).

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* 21. I have participated in learning activities (i.e. workshop, online course).

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* 22. I have enrolled in an educational program (i.e. adult learning program or college.

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* 23. If you answered "Yes" to Question #20, what are you pursuing?

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* 24. I am more interested in volunteering.

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* 25. I am more capable of finding school, work and/or volunteer opportunities.

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* 26. I am now volunteering in the community.

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* 27. Please explain how or what services/groups at the Wellness Center affected your responses to Questions #13 - #24.

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