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* 1. Partner

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* 2. ID (First and Last Name)

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* 3. I am

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* 4. Before I make a decision, I stop to think about the possible consequences.

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* 5. When I feel I am getting angry, I am good at taking a time-out (chill out)

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* 6. I am good at telling a partner/close friend if she/he has done something to hurt my feelings.

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* 7. When a disagreement with a partner or close friend begins to build into a serious fight, I am good at admitting when I might be wrong.

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* 8. I have a clear sense of my physical and emotional boundaries in regards to my (future) relationship.

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* 9. I know what a healthy relationship looks like.

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* 10. I know the qualities I want in a romantic partner.

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* 11. I am aware of what the “love chemicals” in the brain are and what they do.

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* 12. If I love a person it is okay to have sex, even if I’ve known him/her only for a few weeks.

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* 13. If I am going to be sexually active, it is important to have a plan about how to prevent pregnancy or STDs.

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* 14. If I am not going to be sexually active, it is important to have a plan for how to keep the relationship from going too far physically.

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* 15. Having sex is a good way to build a new relationship.

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* 16. I know if a relationship I am in is worth it.

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* 17. I am sure that I can wait to have sex until I am in a stable relationship.

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* 18. Even if I had had sex before, I am sure I can abstain (not have sex) until I am in a stable relationship.

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* 19. I know there is more to building a healthy relationship aside from sex.

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* 20. I have really thought about what is important to me (beyond looks or money) in looking for a partner.

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* 21. I understand the benefits of waiting to have a baby until I am in a stable relationship and have the financial stability to support both.

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* 22. Babies have a higher chance of succeeding in life when both parents are actively involved.

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* 23. Sharing an intimate (nude) photo with your girlfriend/ boyfriend through texting is okay.

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* 24. Sexting with my friend or boyfriend is okay.

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* 25. Pornography is a realistic example of a healthy sexual relationship.

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* 26. My parent/caregiver and I talked about sex.

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* 27. I tell my parents or a trusted adult when I am in a relationship with someone

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* 28. I have engaged in sex at least once before.

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* 29. Before having sex, I have used alcohol or use drugs.

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* 30. The person I am dating texts me or calls me all the time.

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* 31. The person I am dating threatens to hurt me, my friends or family.

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* 32. The person I am dating encourages me to try new things.

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* 33. The person I am dating values my opinions.

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* 34. The person I am dating makes all the decisions (where to go, who to hang out with, what to do).

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* 35. How easy or hard would it be for you to say“no” to sex?

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* 36. How easy or hard would it be to negotiate with your partner to not have sex, even if your partner insisted on it?

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* 37. On how many occasions, if any, have you used alcohol during the last 12 months?

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* 38. My facilitator made the class fun

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* 39. My facilitator was good at having everyone in the group actively participate

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