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  • 1. Date: ___/___/07 Administrator: MY BROTHER’S KEEPER ASSESSMENT Name: Alias: First Middle Last For each statement below, please circle the number that best matches how you feel: Strongly Strongly Agree Possible Disagree Agree Disagree I should get my life on the right 1 2 3 4 5 track I trust the Raleigh Police 1 2 3 4 5 Department I am able to get along with people 1 2 3 4 5 I can succeed in life 1 2 3 4 5 I can turn to family for help 1 2 3 4 5 I respect others 1 2 3 4 5 It is important to me to stay out of 1 2 3 4 5 trouble There are friends that will look out 1 2 3 4 5 for me I am an OK person 1 2 3 4 5
  • 2. Strongly Strongly Agree Possible Disagree Agree Disagree I must follow the laws of this state 1 2 3 4 5 I have the ability to accomplish 1 2 3 4 5 goals I do my best 1 2 3 4 5 I want to help 1 2 3 4 5 I can listen to the opinions of others 1 2 3 4 5 I have the ability to solve problems 1 2 3 4 5 without violence I need to cooperate with this 1 2 3 4 5 program I can get my life on the right track 1 2 3 4 5 I need help 1 2 3 4 5 I have a lot of options in life 1 2 3 4 5 I have a positive attitude 1 2 3 4 5 I need a new living environment 1 2 3 4 5
  • 3. Strongly Strongly Agree Possible Disagree Agree Disagree Many people want me to succeed 1 2 3 4 5 I must stay out of trouble 1 2 3 4 5 I have been treated unfairly by the 1 2 3 4 5 Police Department No program can really help me 1 2 3 4 5 I am aware of opportunities 1 2 3 4 5 I am talented 1 2 3 4 5 I admit that I have a negative 1 2 3 4 5 attitude I am interested in participating in 1 2 3 4 5 this program I have skills 1 2 3 4 5 Cooperation is important 1 2 3 4 5 Life is too hard 1 2 3 4 5 This program really wants to help 1 2 3 4 5 me