Healing Ribbons Girl Check-in If you have a paper copy, you can upload it at the bottom instead of filling out this form. Name First Name Last Name Participant Initials Date MM DD YYYY I have a strong sense of belonging to my tribal community Strongly disagree Disagree Neutral Agree Strongly Agree I have a lot of pride in my tribal community. Strongly disagree Disagree Neutral Agree Strongly Agree How often during the past month did you feel that you had warm and trusting relationships with others? Never Once or twice About once a week About 2-3 times a week Almost everyday Everyday How often during the past month did you feel that you are confident to think or express your own ideas and opinions? Never Once or twice About once a week About 2-3 times a week Almost everyday Everyday How often during the past month did you feel that your life has a sense of direction or meaning to it? Never Once or twice About once a week About 2-3 times a week Almost everyday Everyday How often during the past month did you feel interested in life? Never Once or twice About once a week About 2-3 times a week Almost everyday Everyday I feel connected to the world around me Strongly disagree Disagree Somewhat disagree Somewhat agree Agree Strongly Agree I feel that I am part of a group Strongly disagree Disagree Somewhat disagree Somewhat agree Agree Strongly Agree I am doing just as well as other kids my age Strongly disagree Disagree Somewhat disagree Somewhat agree Agree Strongly Agree Has anyone ever talked to you about female health issues? Yes No Don't Know Has anyone ever talked to you about 1. about how to safely reject people that make you uncomfortable? Yes No Don't Know Thank you!
