Social–Emotional Progress Questionnaire

Student Name: ______________________ Date: _________________

Evaluator: __________________________ Role: ________________

⭐ How to Answer

For each statement, choose the picture or word that fits you best:

😀 Yes, most of the time

🙂 Sometimes

😐 Not yet

(You may circle the face or check the box.)

SECTION 1: Understanding My Feelings (Self-Awareness)

I can tell how I am feeling (happy, mad, worried, excited).

□ 😀 Yes □ 🙂 Sometimes □ 😐 Not yet

I can say what made me feel that way.

□ 😀 Yes □ 🙂 Sometimes □ 😐 Not yet

I can name things that help me calm down.

□ 😀 Yes □ 🙂 Sometimes □ 😐 Not yet

I know what I am good at.

□ 😀 Yes □ 🙂 Sometimes □ 😐 Not yet

SECTION 2: Managing My Feelings (Regulation)

When I feel upset, I can calm myself down.

□ 😀 Yes □ 🙂 Sometimes □ 😐 Not yet

I can stay calm when things change or don’t go the way I expected.

□ 😀 Yes □ 🙂 Sometimes □ 😐 Not yet

I use tools that help me calm down (deep breaths, breaks, fidgets, counting).

□ 😀 Yes □ 🙂 Sometimes □ 😐 Not yet

I need an adult to help me calm down.

□ 😀 Not much □ 🙂 Sometimes □ 😐 Often

SECTION 3: Understanding Others (Social Awareness)

I can tell how someone else might be feeling.

□ 😀 Yes □ 🙂 Sometimes □ 😐 Not yet

I can listen when someone is talking.

□ 😀 Yes □ 🙂 Sometimes □ 😐 Not yet

I try to be kind with my words and actions.

□ 😀 Yes □ 🙂 Sometimes □ 😐 Not yet

SECTION 4: Getting Along With Others (Relationship Skills)

I can start a conversation or join an activity (with or without help).

□ 😀 Yes □ 🙂 Sometimes □ 😐 Not yet

I can work with a partner or group.

□ 😀 Yes □ 🙂 Sometimes □ 😐 Not yet

I can make or keep friends.

□ 😀 Yes □ 🙂 Sometimes □ 😐 Not yet

When I disagree with someone, I can solve the problem calmly.

□ 😀 Yes □ 🙂 Sometimes □ 😐 Not yet

SECTION 5: Making Good Choices (Responsible Decision-Making)

I can stop and think before I act.

□ 😀 Yes □ 🙂 Sometimes □ 😐 Not yet

I follow the classroom rules.

□ 😀 Yes □ 🙂 Sometimes □ 😐 Not yet

I ask for help when I need it.

□ 😀 Yes □ 🙂 Sometimes □ 😐 Not yet

SECTION 6: Student-Friendly Open-Ended Questions

(Use drawings, words, or have the student dictate.)

What makes school hard sometimes?

What helps you feel calm or safe at school?

What do you want to get better at with friends or classmates?

What is something you’ve gotten better at this year?

SECTION 7: Evaluator Notes

Strengths:

Areas to support:

Next steps or strategies: