Name: ___________________________ Age: ________ Gender: Male Female
Economic: Rich Middle Class Poor Status
Please answer the following questions honestly.
I.) Just check whether it’s a YES or NO.
1) Are you aware of the effects of stress?
YES NO
2) Are you still not used of the sudden change of environment from high school to college?
YES NO
3) Do you have family problems/issues?
YES NO
4) Are you being pressured by your friends to do something or be something (peer pressure)?
YES NO
5) Are you alone/doesn’t have friends or being bullied?
YES NO
6) Do you have hard subjects?
YES NO
7) Do you have professors that are mean to you?
YES NO
8) Are you stressed because you don’t have friends?
YES NO
9) Do you have failing grades?
YES NO
10) Are you in a relationship/going out with someone)?
YES NO
11) Do you feel more alert because of stress?
YES NO
12) Have you consider alcohol or cigarette to relieve stress?
YES NO
13) Do you experience having headache or medical issues because of stress?
YES NO
14) Is your academic performance become weaker?
YES NO
15) Do you have ideas how to calm your body and reduce its tension?
YES NO