Activity Structuring Form

Activity Structuring Form
MAIN ACTIVITY
ACTIVITY COMPONENT #1
ACTIVITY COMPONENT #2
ACTIVITY COMPONENT #3
ACTIVITY COMPONENT #4
Where do you want to go after you click the Next button?

Main Activity
Details of Activity Component #1
Before the activity
What will you do?
When will you do it?
What part of the day?
Where will you do it?
Which other people will be involved? What will be their task?
After the activity
Did you perform the planned activity?
Keep trying!
What did you do?
How did you feel?

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Pleasant feelings
Alive
Happy
Good
Interested
Love
Open
Positive
Strong
Difficult / unpleasant feelings
Afraid
Angry
Confused
Depressed
Helpless
Hurt
Indifferent
Sad

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Remarks
Where do you want to go after you click the Next button?

Should be Empty: