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* 1. Today's Date

Date

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* 2. Your Age

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* 3. Birth Gender

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* 4. Class Period

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* 5. In the past month, how often have you felt overwhelmed by your emotions?

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* 6. When you feel sad or upset, do you have someone you can talk to about it?

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* 7. How often do you feel hopeful about your future?

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* 8. Do you think it’s okay to ask for help if you’re feeling anxious or depressed?

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* 9. How connected do you feel to your peers at school?

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* 10. In the past 12 months, have you felt excluded or left out by your peers?

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* 11. How often do you participate in social activities with friends outside of school?

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* 12. On an average school night, how many hours of sleep do you get?

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* 13. How often do you engage in physical activity or exercise?

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* 14. In the past 30 days, how often have you felt physically tired during the school day?

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* 15. Do you feel that you have a sense of purpose or direction in your life?

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* 16. How often do you reflect on things that matter most to you?

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* 17. When faced with a problem, how confident are you in your ability to handle it?

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* 18. In the past 30 days, how often have you felt able to manage stress effectively?

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* 19. In the past 12 months, have you experienced bullying (in person or online)?

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* 20. Do you feel safe at school?

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* 21. Do you know where to go for help at school if you’re feeling unsafe or need support?

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