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Do you participate in any sports besides wrestling? If so, what?
   
 
 
 
Do you live in a single parent home?
 
Yes
 
No
 
 
How satisfied are you with the following:
Very Unsatisfied Unsatisfied Neutral Satisfied Very Satisfied
Social life
School life
Family
Quality of life (overall)
 
 
 
If you are unsatisfied or very unsatisfied with one of the previous questions, why?
   
 
 
 
What is your best asset?
   
 
 
 
What is your biggest weakness?
   
 
 
 
Are you happy with your accomplishments thus far? Why or why not?
   
 
 
 
What could or would you like to change to improve the quality of your life?
   
 
 
 
Are you currently in trouble with your school, parents, or the law? If so, which and why?
   
 
 
 
Do you believe that we can assist you? if so, how and if not, why?
   
 
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