Love + Belonging!

Basic Need Sheet

Rate each question on a scale of 1-10.
1 = lowest 10=highest.
1- 2- 3 - 4- 5 - 6- 7- 8- 9- 10
Love + Belonging:
1. Do you feel loved by those around
you? _________
2. Do you have people in your life you genuinely love and give
to? _________
3. Do you have people in your life you can always rely on in times of need?
_________
4. Do you feel a part of a
community/organization? __________
5. How content are you with your family
relationships? __________
6. How satisfied are you with your active
friendships? __________

1- 2- 3 - 4- 5 - 6- 7- 8- 9- 10

When your done add up all the numbers you chose and divide them by 6. This is your
Love + Belonging score. (1 being the lowest- 10 being the highest)
(If you want a percentage just move the decimal over once to the right. For example: 7.3
is 73%).

Overall Love + Belonging Score: ________

Does your overall Love + Belonging Score feel right? Yes/No + How Come?
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What can you learn about yourself from your Love + Belonging
Score? _______________________________________________________________
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Write the reason you chose each number for the 6 questions on Love + Belonging
above. Remember...Only honesty ;) (Trust me you dont want me to catch you!)
1. ____________________________________________________________________
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2. ________________________________________________________________
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3. ________________________________________________________________
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4. ________________________________________________________________
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5. ________________________________________________________________
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6. ________________________________________________________________
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Now take each love + belonging score from above and write it in the same order below.
Across from it write where you wish to score.

1. I gave myself a _________however I wish to achieve a number: __________

2. I gave myself a_________ however I wish to achieve a number: __________
3. I gave myself a_________ however I wish to achieve a number: __________
4. I gave myself a_________ however I wish to achieve a number: __________
5. I gave myself a_________ however I wish to achieve a number: __________
6. I gave myself a_________ however I wish to achieve a number: __________

Write what you can do to achieve your number goal in each line. If you have already
reached a 10 what could you do to maintain the 10? Dont forget to be honest ;)

1. ________________________________________________________________
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2. ________________________________________________________________
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3. ________________________________________________________________
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4. ________________________________________________________________
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5. ________________________________________________________________
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6. ________________________________________________________________
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