STUDENT SELF AWARENESS FORM -

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 My name is ………………………………………
Affix your latest
 I am well adjusted in /trying to adjust in/not able to
passport sized
adjust in…………….class.
photograph (in
 My blood group is……………………
school uniform)
PHASE –I (______________)
1. When I grow up I want to be : (Long Term Goal);.
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2. What steps are required to achieve my goal? (Long Term Goal)

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3. What I want to achieve this year? (Short Term Goal)
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4. What steps are required to achieve my immediate goal?(Short Term Goal)
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5. Which of my qualities will help me to achieve this goal?(STRENGTH)
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6. Which of my qualities can stop me from achieving this goal?(WEAKNESS)
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7. How will I overcome my weakness?(CONTROL)
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SIGNATURE…………………….. Date……..,./…./………
NAME____________________CLASS________ SECTION__________________

PHASE-II (_______________)
1. Do I remember my goals? Yes/No. ____________ If yes,

A) What is my Long Term Goal?

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B) What is my Short Term Goal?

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2. Am I working to achieve my Short Term Goal? Yes/No. ________ If yes,
A) What are the steps taken to achieve it?
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B) To what extent have I achieved it?
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C) What more I need to be closer to my goals?
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D) Am I being distracted from achieving my goals? Yes/No._____ If yes,
What are these distractions?
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E) How will I overcome these? (So that I can achieve my Short Term Goal)
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3. My Additional qualities/Strength gained:
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4. Have I controlled my weaknesses? If yes, How?
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If No, A) Why Not?

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B) What should I do to control it?

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NAME & SIGNATURE____________________________ DATE_________

NAME____________________CLASS________ SECTION__________________

PHASE-III (_______________)
1. My achievements of this session:
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2. Have I achieved my Short term Goal? Yes/No .
3. If Yes, I was able to achieve my Short Term Goal:
a. With lots of efforts
b. With some efforts
c. Easily
d. Very easily
e. Any other………………………………………………………………………………………………………………………………………

If No, I was not able to achieve my short term goal:

a. I had decided higher goal for myself

b. I could not overcome my distractions
c. I tried but still I need to put on more efforts
d. I was not serious about it
e. Any other……………………………………………………………………………………………………………………………………..

 Strategies that would work best for me:

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4. I am feeling?

5. Any special time/event of the session I cherish? Why?

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6. Any pleasant or unpleasant incident that took place in the school/Family during this academic session:
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7. Now for the next session- My Resolution is to achieve:
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8. My feelings about the school:
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NAME & SIGNATURE____________________________ DATE_________