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