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Do you have a part-time job?
 
Yes
 
No
 
 
 
How do you perform academically?
 
Below 50%
 
50%-60%
 
60%-70%
 
70%-80%
 
Above 80%
 
 
 
What activities do you do on a weekly basis? (Select all that apply)
 
Work
 
Play sports
 
Participate in extracurriculars
 
Volunteer
 
Spend time with friends/family
 
Religious activities 

 
 
 
If you answered yes to having a part-time job, how many hours a week do you work?
 
1-10
 
10-20
 
20-30
 
Above 30
 
I don't work
 
 
 
Do you feel that you struggle with time management?
 
Often
 
Sometimes
 
Rarely
 
Never
 
 
 
How do you feel about your job?
 
I like my job
 
It's alright
 
I don't like it
 
I don't have a job
 
 
 
How do you feel about your studies?
 
I am a good student
 
I have stuff to work on
 
I am not a good student
 
I don't feel anything about my studies
 
 
 
How much homework do you feel you get in a day? 
 
I get too much
 
A fair amount
 
It depends
 
I get none
 
 
 
Do you do drugs?
 
Yes
 
No
 
Sometimes
 
 
 
I feel ________ about my family relationships. (Select all that apply)
 
Good
 
Happy
 
Upset
 
Angry
 
Confused
 
Comfortable