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What age describes you?
 
17-19
 
20-22
 
23-25
 
26+
 
 
 
Gender:
   
 
 
 
Race/ Ethnicity:
   
 
 
 
Sexual Orientation:
   
 
 
 
What is your year in school?
 
Freshman
 
Sophomore
 
Junior
 
Senior
 
Graduate student
 
 
 
Describe your hometown
 
Urban
 
Suburban
 
Rural
 
International
 
 
 
When you are feeling stressed or distressed, how do you cope?
 
Talk to someone
 
Distract with computer/ hobbies/ interests
 
Misuse food, alcohol, or drugs
 
Demonstrate aggressive behaviors
 
Exercise
 
Other
 
 
 
 
Have you ever experienced suicidal thoughts?
 
Yes
 
No
 
 
 
When did you experience suicidal thoughts? (Select all that apply)?
 
within the last month
 
within the last 6 months
 
within the last year
 
during my college experience
 
prior to my college experience

 
 
 
If you experienced suicidal thoughts, what do you feel contributed to your distress (Select all that apply)?
 
School/Work
 
Relationship
 
Trauma
 
Friends/Family
 
Personal Wellness
 
Other