Name:
  Phone Number:
  Email Address:


  I recognize my
  emotions.  
Never
Almost Never
Sometimes
Frequently
Almost Always
Always
  I effectively express   
  my feelings.  
Never
Almost Never
Sometimes
Frequently
Almost Always
Always
  I understand how   
  others feel.  
Never
Almost Never
Sometimes
Frequently
Almost Always
Always
  I use my emotions   
  to improve   
  decisions.  
Never
Almost Never
Sometimes
Frequently
Almost Always
Always
  I maintain a   
  positive mood.  
Never
Almost Never
Sometimes
Frequently
Almost Always
Always
  I positively   
  influence moods of   
  others.  
Never
Almost Never
Sometimes
Frequently
Almost Always
Always
  I respond   
  creatively to   
  emotions.  
Never
Almost Never
Sometimes
Frequently
Almost Always
Always