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Teen Dating Readiness Gauge Free

1.
***In the following scale below from 1 to 10, please choose the number that most accurately reflects where your student is today.
Your Student’s Inspection Report (Your Student’s Current Condition)
“I know what I want.”
“I have a specific vision for the direction of my life and know what my intention is for seeking a relationship. I am very clear about the consequences of being in an unhealthy relationship and I understand the potential consequences of signing an emotional contract with someone at this stage of my life.”

 

  • Strongly disagree
  • Somewhat Disagree
  • Neutral
  • Somewhat Agree
  • Strongly Agree
 
 
 
 
 
 
 
 
 
 

2. ***In the following scale below from 1 to 10, please choose the number that most accurately reflects where your student is today.
Your Student’s Maintenance Report (Your Student’s Current Needs)
“I am aware of my requirements.” 
“I have a written list of no less than ten non-negotiable requirements that I use for screening potential future dates. I am clear that if any are missing, a relationship won’t work for me. I am accountable for being the best possible human being I can be and I am not willing to compromise my morals or values in any way. I understand that my brain is not yet fully developed and this period of life is to become educated on how to make positive relationship choices and build healthy social skills.”

 

  • Strongly disagree
  • Somewhat Disagree
  • Neutral
  • Somewhat Agree
  • Strongly Agree
 
 
 
 
 
 
 
 
 
 

3.
***In the following scale below from 1 to 10, please choose the number that most accurately reflects where your student is today.
Your Student’s Mileage Report (Your Student’s Lifestyle)
“I am content being single.”
“I appreciate my life, my education, my family, my friends, and enjoy my own company. I’m heading in a healthy, positive direction toward the future life that I want, and I’m not seeking a relationship out of desperation or need. I have a healthy, active social life and my friends are strong, successful, encouraging individuals, which complete my social needs. I contribute in a positive way to all my relationships.”

 

  • Strongly disagree
  • Somewhat Disagree
  • Neutral
  • Somewhat Agree
  • Strongly Agree
 
 
 
 
 
 
 
 
 
 

4.
***In the following scale below from 1 to 10, please choose the number that most accurately reflects where your student is today.
Your Student’s Consumer Report (Your Student’s Safety and Health)
“I recognize that I am not ready or available for a long-term commitment at this stage of my life.”
“I have no emotional, immoral or illegal baggage currently or from my past that I have not addressed. My school, home and extra-curricular schedule, commitments and lifestyle will continue to be my priority and will come before my availability to develop a dating relationship. I am drug, alcohol, sex and anger free. I do not engage in bullying, gossip, slander or sexual harassment. I understand the scope and the consequences of violence and abuse and I am firmly committed to avoiding all forms of these behaviors.”

 

  • Strongly disagree
  • Somewhat Disagree
  • Neutral
  • Somewhat Agree
  • Strongly Agree
 
 
 
 
 
 
 
 
 
 

5.
***In the following scale below from 1 to 10, please choose the number that most accurately reflects where your student is today.
Your Student’s Performance Rating (Your Student’s Attitude)
“I’m content with my life.”
“My school, home-life, social-life and private-life are rewarding and fulfilling. I am not depressed, anxious or stressed and understand that any new relationship should never interfere or disrupt the balance of the other areas of my life. I am careful about what I allow into my thought process and understand the influence social media has on my view of relationships.”

 

  • Strongly disagree
  • Somewhat Disagree
  • Neutral
  • Somewhat Agree
  • Strongly Agree
 
 
 
 
 
 
 
 
 
 

6.

***In the following scale below from 1 to 10, please choose the number that most accurately reflects where your student is today.
Your Student’s Chasis (Your Student’s Body)

“I’m healthy in mind, body, and spirit.”
“My physical, mental, or emotional wellbeing is of primary importance and anything that competes with my wellbeing will not be continued. I carefully monitor what goes into my body and I am responsible for my diet, my thought process, my personal belief system, my sleep and my emotions. I hold no one other than myself accountable for managing my overall health.”

 

  • Strongly disagree
  • Somewhat Disagree
  • Neutral
  • Somewhat Agree
  • Strongly Agree
 
 
 
 
 
 
 
 
 
 

7.
***In the following scale below from 1 to 10, please choose the number that most accurately reflects where your student is today.
Your Student’s Financing Options (Your Student’s Income)
“I am able to self-fund my social life.”
“I have a consistent means to provide an allowance or income for the social activities I am interested in pursuing including potential dates. I understand my parents, friends and dates are not responsible for funding my social life. I am aware that I am not entitled to money for anything other than the necessary food, shelter and clothing provided to me by my parents or guardians. I am grateful for the opportunity to work and recognize the value of a dollar.”

 

  • Strongly disagree
  • Somewhat Disagree
  • Neutral
  • Somewhat Agree
  • Strongly Agree
 
 
 
 
 
 
 
 
 
 

8.
***In the following scale below from 1 to 10, please choose the number that most accurately reflects where your student is today.
Your Student’s Manufacturer (Your Student’s Parents)
“My own family relationships are healthy.”
“I understand that it is my responsibility to be caring, kind, truthful and respectful in my relationships with my siblings, parents, and friends. I understand that how I treat these relationships will have a direct impact on a future dating relationship.”

 

  • Strongly disagree
  • Somewhat Disagree
  • Neutral
  • Somewhat Agree
  • Strongly Agree
 
 
 
 
 
 
 
 
 
 

9.
***In the following scale below from 1 to 10, please choose the number that most accurately reflects where your student is today.
Your Student’s “DateFax” Report (Your Student’s Reputation)
“I have developed mature and effective relationship abilities for my age.”
“I initiate contact with people I wish to meet, and disengage from people who have a negative impact on me. I maintain my physical, mental, emotional, spiritual and financial boundaries and balance my heart with my head in all my relationships. I know the difference between right and wrong and I do not hesitate to act accordingly regardless of peer pressure or self-indulgence. Those who know me can verify my past and have positive things to say about me. Safety and responsibility are my top priorities for dating relationships.”

 

  • Strongly disagree
  • Somewhat Disagree
  • Neutral
  • Somewhat Agree
  • Strongly Agree
 
 
 
 
 
 
 
 
 
 

10.
***In the following scale below from 1 to 10, please choose the number that most accurately reflects where your student is today.
Your Student’s Options (Your Student’s Qualities and Characteristics)
“I have mature relationship skills.”
“I fully grasp the complexity of relationships; I can develop closeness and intimacy without sexual activity. I communicate authentically and assertively, settle differences positively, allow myself to trust my feelings and communicate openly. I can give and receive love without emotional barriers, insecurities or any anger response. I understand my words have power and use them carefully.”

 

  • Strongly disagree
  • Somewhat Disagree
  • Neutral
  • Somewhat Agree
  • Strongly Agree
 
 
 
 
 
 
 
 
 
 

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