PreK-2 Universal Wellness Assessment
This survey will ask about how you are feeling and about things that may have happened to you. All students in your school are taking this survey so that anyone who is having a hard time can get help if they need it. There are no right or wrong answers, but try to answer the questions honestly. Your answers may be shared with other adults at school who can help. If you aren’t sure what a question means, you can ask your teacher to help explain it. If there are questions you do not want to answer, you can skip them.
Sign in to Google to save your progress. Learn more
Student First and Last Name *
What is your teacher's name?
Use the chart below to choose which face shows how you have been feeling most of the time during the past 2 weeks (happy, sad, mad, scared/worried).
Clear selection
Use the chart below to choose how strongly you have been feeling sad, mad, or scared during the past 2 weeks.
Captionless Image
Clear selection
Do you have a safe adult you can talk to about your feelings?
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Sparta Schools.

Does this form look suspicious? Report

Google Forms