Prime for Life Class Sample One

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Student Name
Address
Are you a WCU Student?
Do You Accept Our Terms and Conditions?
Involvement with Law Enforcement or Courts in Previous 12 Months?
School dropout (< Age 18)
Academic Difficulty / Repeated failure in school (< Age 18)
Pregnant female
Economically disadvantaged / Free or reduced lunch
Victim of physical , sexual, or psychological abuse or other trauma (< Age 18)
Has committed a violent or delinquent act (< Age 18)
Current or past mental health issues or disorders
Has attempted suicide in the past
Current or past long-term physical pain due to injury
Is or has been involved in the Juvenile Justice System (< Age 18)
Is physically disabled
Legally uses alcohol without evidence of abuse
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