* 1. How old are you?

* 2. What is your gender?

* 3. What grade are you in?

* 4. On average, how many hours of sleep do you get each night?

* 5. Are you expriencing any of the following family problems?

* 6. Are you having difficulty in school?

* 7. Are you expriencing trouble with friends?

* 8. How do you deal with stress?

* 9. Recently, have you experienced any of the following emotional signs?

* 10. Have you been experiencing any of the following physical signs?

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