1. What do you identify as? *
2. What grade are you in? *
3. What grade average feels appropriate for you? *
4. Approximately what time do you go to bed at night? *
Your answer
5. Approximately what time do you wake up in the morning? *
Your answer
6. What level are most of your classes? *
7. How often do you fall asleep or get drowsy in class? *
8. Are you usually alert most of the day? *
9. How often do you feel stressed / overwhelmed when trying to sleep? *
10. How often do you feel well-rested? *
11. Please rate the following sources of stress. *
0 - Never
1 - Barely Ever
2 - Sometimes
3 - 0ften, Frequently
4 - Very Often, Always
academic demands
issues with family
balancing a job and school
12. How often do you find it difficult to relax? *
13. How often do you feel overworked? *
14. How often do you feel there is not enough time to complete a task? *
15. Do you feel that lack of sleep affects your ability to perform well in school? *
If you answered yes or sometimes to the previous question, would you consider taking part in a follow up interview? If yes, please provide your name and homeroom. If No, please leave this question blank.
Your answer
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