Self-Assessment Wheel Worksheet

Purpose: Reflect on your wellness across six dimensions by rating and shading each segment of the wheel.

Instructions:

1. Draw or use the blank wheel template below. Divide the circle into six equal slices.
2. Label each slice with one of the following dimensions:
   • Physical
   • Emotional
   • Social
   • Intellectual
   • Spiritual
   • Environmental
3. For each dimension, rate your current wellness level on a scale of 1 (low) to 10 (high). Write the number next to the slice label.
4. Shade or color each slice up to your self-rating (e.g., shade 7/10 of the slice for a rating of 7).
5. Once all slices are shaded, connect the outer edges of your shaded areas to see your personal wellness “shape.”

[BLANK WHEEL – teacher: print or project for students to trace]

⬤
/|\
/ | \
–––––––
\ | /
|/
◯

Note: you may provide a larger, neatly drawn circle divided into six slices instead of the simple sketch above.

Reflection Questions:

1. Which dimension did you rate highest, and what strengths or habits support that score?
   
   
   
   
   
2. Which dimension did you rate lowest, and what factors influenced that rating?
   
   
   
   
   
3. How do your daily routines or habits align with these ratings?
   
   
   
   
   

Once you’ve completed and reflected on your wheel, be ready to share your insights with a partner in the next activity.

Goal-Setting Guide Worksheet

Purpose: Use the SMART framework to turn your lowest-scoring wellness dimension into a clear, actionable goal.

1. Focus Dimension
   Which wellness area will you improve? (Physical, Emotional, Social, Intellectual, Spiritual, or Environmental)
   
   
   

2. General Goal Statement
   Write a one-sentence goal to describe what you want to achieve:
   
   
   
   

3. SMART Goal Details
   • Specific: What exactly do you want to accomplish?
   
   
   
   
   
   • Measurable: How will you track or measure your progress?
   
   
   
   
   
   • Achievable: Is this goal realistic? What skills or resources will help you succeed?
   
   
   
   
   
   • Relevant: Why is this goal important to your overall wellness?
   
   
   
   
   
   • Time-bound: When will you complete this goal? (Include specific dates or deadlines)
   
   
   
   
   

4. Final SMART Goal
   Combine the elements above into one concise statement:
   
   
   
   
   
   

5. Action Steps
   List at least three concrete actions you will take to achieve your SMART goal:

6. __________________________________________
   
   

7. __________________________________________
   
   

8. __________________________________________
   
   

9. Check-In Plan
   When and how will you review your progress? (e.g., weekly reflections, partner check-ins)
   
   
   
   
   

10. Anticipated Challenges & Solutions
    • Challenge: ________________________________
    
    
    Solution: ________________________________
    
    

• Challenge: ________________________________


Solution: ________________________________

Keep this guide handy and revisit it regularly to stay on track with your wellness goals!

Assessment Key for Goal-Setting Guide

Total Points: 15
Use this rubric to quickly evaluate each student’s SMART goal worksheet. Assign full, partial, or no credit based on the descriptors below.

Teacher Notes & Scoring Guidance:

1. Skim each section to confirm presence and clarity of required elements.
2. For incomplete or vague responses, award partial credit and note which details are missing.
3. Provide targeted feedback encouraging students to refine any SMART component that is unclear or unrealistic.
4. Record the total score out of 15, then discuss common areas for improvement with the class during closure.