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  2. 2015
  3. September
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  5. L2B
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Hello:
You are invited to participate in our survey. It will take approximately 5-10 minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential.

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.
 
 
 
What is your gender?
 
Male
 
Female
 
 
 
How old are you?
 
14
 
15
 
16
 
17
 
 
 
Please put your computer number
   
For the following questions identify areas of your life that you may have difficulty managing by indicating a "Yes" or "No":
   
1. Relationship with peers
   
2. Relationships with parents
   
3. Relationships with teachers
   
4. School work
   
5. Managing emotions that are upsetting to me
   
6. Letting go of thoughts
   
7. Physical health
   
8. Sleep
   
9. Dealing with stress in my life
   
 
 
 
Overall, describe how you feel you cope with stresses in your life
 
Very Poor
 
Poor
 
Acceptable
 
Good
 
Very Good
 
 
 
Overall, describe your quality of sleep
 
Very Poor
 
Poor
 
Acceptable
 
Good
 
Very Good
 
 
 
Overall, describe any problem physical symptoms (for example, headaches, back pain, tiredness, etc.) you may have
 
Very Poor
 
Poor
 
Acceptable
 
Good
 
Very Good
 
 
 
Overall, describe your ability to take care of yourself (for example, eating well, not judging yourself too harshly, etc.)
 
Very Poor
 
Poor
 
Acceptable
 
Good
 
Very Good
 
 
 
Overall, describe your level of awareness of what is stressful in your life
 
Very Poor
 
Poor
 
Acceptable
 
Good
 
Very Good
 
 
 
Overall, describe your ability to be in control of difficult emotions and situations in your life
 
Very Poor
 
Poor
 
Acceptable
 
Good
 
Very Good
 
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