Resident Stage 3 Self Assessment

Fill out the following form and press submit

Resident Self-Assessment Questionnaire – Stage 3

Purpose: This self-assessment helps you reflect on your progress, personal growth, and relationships during this next stage of the program. It also allows you to take part in your care planning and encourages you to input into the decision-making process for our journey through the program.

SECTION 1 – PERSONAL REFLECTION

1. What have you learned about managing your life and recovery independently during Stage 3?(Required)

2. How have you maintained structure and consistency without constant supervision?(Required)

3. In what areas do you still rely on staff or peers for motivation or accountability?(Required)

4. How have you demonstrated self-discipline, honesty, and reliability?(Required)

5. What have been your greatest achievements and challenges in this stage?(Required)

SECTION 2 – LEADERSHIP, MENTORING, AND RESPONSIBILITY

1. How have you taken the initiative or provided leadership within the house or program?(Required)

Always

Often

Sometimes

Rarely

2. How effectively have you supported or mentored newer residents?(Required)

Excellent

Good

Fair

Poor

3. Give examples of times you have helped resolve conflict or modelled positive behaviour.(Required)

4. How do you encourage teamwork and accountability among residents?(Required)

5. What responsibilities have you taken on that show readiness for more independence?(Required)

SECTION 3 – RELATIONSHIPS, COMMUNICATION, AND BOUNDARIES

1. How have you developed and maintained healthy boundaries with peers and staff?(Required)

2. How do you respond when disagreements or misunderstandings occur?(Required)

3. In what ways have you demonstrated empathy and respect in relationships?(Required)

4. How do you balance being supportive to others while maintaining your own recovery focus?(Required)

5. How do you handle relationships and influences outside the program?(Required)

SECTION 4 – EMOTIONAL, SPIRITUAL, AND PERSONAL GROWTH

1. How has your emotional maturity or spiritual life grown during this Stage?(Required)

2. What coping strategies or recovery tools do you now use naturally and consistently?(Required)

3. How have you worked on areas such as pride, patience, or forgiveness?(Required)

4. What changes show that your decision-making is more thoughtful and values-based(Required)

5. How are you preparing emotionally and spiritually for life beyond the structured program?(Required)

SECTION 5 – TRANSITION GOALS AND READINESS

1. What are your short-term and long-term goals for the next part of your program?(Required)

2. What plans do you have for work, study, or service involvement?(Required)

3. How are you preparing to manage finances, relationships, and daily responsibilities after leaving residential care?(Required)

4. What ongoing support or accountability will you need for the next part of your program?(Required)

5. Is there anything else you would like to share about your readiness to progress?(Required)

Resident Name(Required)

E-Signiture(Required)

Date