Survey Questionnaire

Demographic:
1.
2.
3.
4.

How old are you?

Are you a Male or a Female?
What is your school year?
What is your GPA?

Knowledge related:
1. Name one healthy way to cope with stress.
Skill related:
1. Do you use an agenda?
a. Yes
b. No
2. On a scale of 1 to 10, how are your time management skills?
Awareness related:
1. Are you aware of the resources available on campus that may help you reduce
stress?
a. Yes
b. No
Intention related:
1. You have a stressful day at school. What do you do when you come home?
2. Do you talk to a professional about your issues?
Behavior related:
1. How many hours per week do you exercise?
a. I do not exercise
b. 1-3 hours per week
c. 4-8 hours per week
d. 9-12 hours per week
e. 13 +
2. On a scale of 1 to 10, how would you rate your diet?

3. Do you believe that you have a well balance diet, with all the necessary nutrients?
a. Yes
b. Sometimes
c. No
4. How many hours of sleep do you get each night?
a. Less than 5
b. 6-7 hours
c. 8-9 hours
d. 10+
5. About how many hours did you spend studying this week?
a. None
b. 1-3 hours
c. 4-8 hours
d. 9+
6. How many days a week do you go out?
7. How many days a week do you consume alcohol/other drugs?
8. Do you procrastinate/ wait until last minute to complete schoolwork? Concerns
a. Yes
b. No
Environmental attributes:
1. Do you have a job?
a. Yes
b. No
2. If yes, how many hours per week do you work?
3. Are you involved in clubs/activities on campus?
a. Yes
b. No

4. Do you live on or off campus?

a. On
b. Off
c. Commute
5. Does spending time with friends or family help reduce your stress?

a. Yes
b. No