Healthy Transitions Grade 7 "Getting to Know you" Questionaire
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Thank you for participating in this program. We look forward to getting to know you over the next few weeks! We will be talking about things like: ways to feel good about yourself, how to deal with stress and cope with life's problems, and how to get help if you need it.

Your answers are confidential and only the Healthy Transitions Counsellors will see these questionnaires. It is very important that you answer the questions honestly. You will NOT get in trouble for any of your answers.

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1. You are:

You are: Male

Female

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2. Who do you live with?

Who do you live with? Two parents (includes step-parents)

One parent

Neither parent (Example, if you live with a relative, a friend or in a group home)

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3. Which of the following things have happened in the past year? Check all that apply to you.

Which of the following things have happened in the past year? Check all that apply to you. I have got in in trouble at school

My parents divorced or separated

A family member, close friend or pet died

I, or someone close to me had a serious injury or illness

I moved or changed schools

I have drank alcohol

I have smoked cigarettes

I have used illegal drugs

I have hurt myself on purpose

I have got in trouble with the law

I have broken up with a boy/girlfriend

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4. Please select the choice that best describes how often you have had these feelings over the past month.

	Almost Never	Sometimes	Most of the Time
Angry	*Please select the choice that best describes how often you have had these feelings over the past month. Angry Almost Never	Angry Sometimes	Angry Most of the Time
Happy	Happy Almost Never	Happy Sometimes	Happy Most of the Time
Sad	Sad Almost Never	Sad Sometimes	Sad Most of the Time
Stressed Out	Stressed Out Almost Never	Stressed Out Sometimes	Stressed Out Most of the Time
Worried	Worried Almost Never	Worried Sometimes	Worried Most of the Time

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5. People have different ways of reacting to stress and dealing with worries and problems. What do you do when things bother/upset you? (Please check the one that applies to you the most for each row)

	Almost Never	Sometimes	Most of the Times
I try not to think about it	*People have different ways of reacting to stress and dealing with worries and problems. What do you do when things bother/upset you? (Please check the one that applies to you the most for each row) I try not to think about it Almost Never	I try not to think about it Sometimes	I try not to think about it Most of the Times
I keep my feelings to myself	I keep my feelings to myself Almost Never	I keep my feelings to myself Sometimes	I keep my feelings to myself Most of the Times
I talk to an adult I trust	I talk to an adult I trust Almost Never	I talk to an adult I trust Sometimes	I talk to an adult I trust Most of the Times
I talk to a friend I trust	I talk to a friend I trust Almost Never	I talk to a friend I trust Sometimes	I talk to a friend I trust Most of the Times
I like to be by myself	I like to be by myself Almost Never	I like to be by myself Sometimes	I like to be by myself Most of the Times
I cry	I cry Almost Never	I cry Sometimes	I cry Most of the Times
I feel sick- headache, stomach ache, etc.	I feel sick- headache, stomach ache, etc. Almost Never	I feel sick- headache, stomach ache, etc. Sometimes	I feel sick- headache, stomach ache, etc. Most of the Times
I scream, yell, swear	I scream, yell, swear Almost Never	I scream, yell, swear Sometimes	I scream, yell, swear Most of the Times
I spend time with friends	I spend time with friends Almost Never	I spend time with friends Sometimes	I spend time with friends Most of the Times
I try to work the problem out myself	I try to work the problem out myself Almost Never	I try to work the problem out myself Sometimes	I try to work the problem out myself Most of the Times
I take my frustration/ anger out on others	I take my frustration/ anger out on others Almost Never	I take my frustration/ anger out on others Sometimes	I take my frustration/ anger out on others Most of the Times
I break or destroy things	I break or destroy things Almost Never	I break or destroy things Sometimes	I break or destroy things Most of the Times
I get physically aggressive (hitting people, walls)	I get physically aggressive (hitting people, walls) Almost Never	I get physically aggressive (hitting people, walls) Sometimes	I get physically aggressive (hitting people, walls) Most of the Times
I do something I enjoy doing (hobby, past time)	I do something I enjoy doing (hobby, past time) Almost Never	I do something I enjoy doing (hobby, past time) Sometimes	I do something I enjoy doing (hobby, past time) Most of the Times
I get active (play sport, go for a run, ride)	I get active (play sport, go for a run, ride) Almost Never	I get active (play sport, go for a run, ride) Sometimes	I get active (play sport, go for a run, ride) Most of the Times

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6. Would you be willing to get help if you needed it? (Check one)

Would you be willing to get help if you needed it? (Check one) No

Maybe

Yes

If "no" or "maybe" tell us why:

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7. Who are the people who help you the most with your problems? (Check all that apply)

Who are the people who help you the most with your problems? (Check all that apply) Parent Relative (grandparent, aunt/ uncle, cousin) Sibling (brother/ sister) Friend	Teacher Coach Minister, pastor, church leader
Other (please specify)

8. Is there anything that you would like to discuss with one of the Healthy Transitions Counsellors? If yes, please write your name and how/ where we can reach you!

Is there anything that you would like to discuss with one of the Healthy Transitions Counsellors? If yes, please write your name and how/ where we can reach you!

Thank you for your time and honesty, we really appreciate it!

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Healthy Transitions Grade 7 "Getting to Know you" QuestionaireExit this survey >>

*1. You are:

*2. Who do you live with?

*3. Which of the following things have happened in the past year? Check all that apply to you.

*4. Please select the choice that best describes how often you have had these feelings over the past month.

*5. People have different ways of reacting to stress and dealing with worries and problems. What do you do when things bother/upset you? (Please check the one that applies to you the most for each row)

*6. Would you be willing to get help if you needed it? (Check one)

*7. Who are the people who help you the most with your problems? (Check all that apply)