Has Being Involved with the Programs of Transition House, Inc., Helped to Improve Your Quality of Life?
To help provide feedback to Transition House, Inc., if you have been a Transitional Living or Outreach Client of the agency, please complete the following and return it to Transition House, Inc. To complete this form, print out this page, or copy it into a Word document and either mail it to Transition House, Inc., 700 Asp, Ste. 2, Norman, OK 73069 or e-mail to transitionhouse@coxinet.net. If you have any questions, you can call Bonnie at 360-7926 or e-mail transitionhouse@coxinet.net.
TRANSITION HOUSE, INC.
QUALITY OF LIFE SCALE (QOL)
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Name:
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Age:
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Date: |
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If
former Transitional Living Client, How Long Since You Left the TL Program? |
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Please read each item and circle the number
that best describes how satisfied you are at this time. Please answer each
item even if you do not currently participate in an activity or have a
relationship. You can be satisfied or dissatisfied with not doing the
activity or having the relationship.
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7.
Mostly Delighted 6.
Pleased 5. Satisfied
4. Mixed 3
Dissatisfied 2.
Unhappy 1.Terrible |
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Questions
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Your
Score |
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1. |
Living
Situation |
7
6 5
4 3
2 1 |
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2. |
Health
- being physically fit and active |
7
6 5
4 3
2 1 |
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3. |
Family
Relationships |
7
6 5
4 3
2 1 |
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4. |
Having
and raising children |
7
6 5
4 3
2 1 |
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5. |
Close
relationships with significant other |
7
6 5
4 3
2 1 |
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6. |
Close
friends |
7
6 5
4 3
2 1 |
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7. |
Helping
and encouraging others |
7
6 5
4 3
2 1 |
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8. |
Participating
and Belonging to Community |
7
6 5
4 3
2 1 |
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9. |
Learning-
improving understanding, gaining additional knowledge |
7
6 5
4 3
2 1 |
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10. |
Understanding
yourself - knowing your assets and limitations |
7
6 5
4 3
2 1 |
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11. |
Meaningful
Work (paid or unpaid) |
7
6 5
4 3
2 1 |
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12. |
Expressing
Creativity - Participating in Hobbies or Activities for Fun |
7
6 5
4 3
2 1 |
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13. |
Socializing
- meeting other people, doing things, etc |
7
6 5
4 3
2 1 |
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14. |
Self-Sufficiency
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7
6 5
4 3
2 1 |
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15. |
Financial
Situation |
7
6 5
4 3
2 1 |
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16. |
Education |
7
6 5
4 3
2 1 |
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17. |
Ability
to Communicate |
7
6 5
4 3
2 1 |
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Total Your Score |
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Rate How Your Involvement With Transition House,
Inc., Improves Your Quality of Life |
7
6 5
4 3
2 1 |
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