Life Assessment Tool

Notice with Respect to Collection of Personal Information

The information on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act and the Freedom of Information and Protection of Privacy Act. This information will be used for the delivery of Wellington County Learning Centre programs and services; and the maintenance of related databases, registries and related research, in compliance with legal and regulatory requirements. Any questions about the collection of this information should be addressed to Ken Harvey, Circles Coordinator at 1.800.265.7294 x 3062.

Food Assessment

Housing Assessment

Transportation Assessment

Support System Assessment

Mental Health Assessment

Rosenberg Self-Esteem Survey

Directions: Please choose the option which best matches your agreement with each statement below.