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Pre-Class Participant Survey YIOC
Instructions: On a scale from 1 to 5, please rate how you’re feeling before class.
Email *
First Name:
 *
Last Name:
 *
Date:
 *
MM
/
DD
/
YYYY
1. I feel calm and at ease. *
Required

 2. I feel present and connected to my body.

 *
Required

3. I feel mentally focused.

 *
Required

4. I feel emotionally balanced.

 *
Required

5. I feel stressed or tense.

*
Required

 6. I feel anxious or overwhelmed.

*
Required

7. I feel safe and supported at this moment.

 *
Required
8. I feel able to stay calm and think clearly when faced with conflict.  *
Required
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