Student Stress Survey
Name (optional)
First Name
Last Name
Year of Birth
Grade
Please Select
Frreshman
Sophomore
Junior
Senior
Post-Graduate
Other
Gender
Please Select
Female
Male
Transgender
Gender-neutral
Prefer not to say
1. How many hours do you spend to do your homework at a school night?
Less than 1 hour
1-2 hours
3-4 hours
4-5 hours
More than 5 hours
2. How many hours do you spend to do your homework during weekends?
Less than 1 hour
1-2 hours
3-4 hours
4-5 hours
More than 5 hours
3. How many hours of sleep do you usually get on a school night?
Less than 7 hours
7-8 hours
8-9 hours
More than 9 hours
4. How much stress do you think you have on average?
None
1
2
3
4
5
6
7
8
9
Extremely Stressed
10
1 is None, 10 is Extremely Stressed
5. Which of the following causes most stress? (select all that apply)
Student issues
Financial issues
Family issues
Friends issues
Romantic relationship issues
Health related issues
Sport/athletic activities
Student clubs/organization issues
Other
6. What are the consequences of stress in your daily life? (select all that apply)
Decrease in activity level
Decreased efficiency and effectiveness
Difficulty on communicating
Inability to rest or relax down
Change in eating habits
Using tobacco/alcohol
Excess usage of caffeine
Accident prone
Other
7. What are the emotional or psychological consequences of stress that you have noticed so far?
Feeling heroic, euphoric or invulnerable
Denial
Anxiety or fear
Worry about safety
Irritability or anger problems
Restlessness
Sadness
Depression
Feeling overwhelmed
Feeling isolated, lonely, lost, or abandoned
Feeling unappreciated
None of the above
Other
8. What are the psychical effects of stress that you experienced?
Increased heart rate/Tachycardia
Increased blood pressure
Upset stomach, diarrhea
Getting too much weight
Loosing too much weight
Sweating
Muffled hearing
Headache
Sore or aching muscles
Light sensitive vision
Tunnel vision
Lower back pain
Neck pain
Changing in menstrual cycle
Change in sexual desire
Weakness for cold, flu
Flare up of allergies
Hair loss
Increase itching
None of the above
Other
9. What are the cognitive effects of stress that you experienced?
Memory problems
Disorientation
Confusion
Difficulty in basic calculations
Concentration difficulty
Getting slower in thinking and analyzing
None of the above
Other
10. What are the social effects of stress that you experienced?
Isolating from people
Listening difficulties
Having problems in sharing ideas
Blaming
Critisizing
Increased intolerance
Difficulty in giving or accepting support
Impatience
None of above
Other
11. Which of the following do you apply when you feel stressed? (select all that apply)
Sleeping
Taking a walk
Going to gym/exercise
Eating
Drinking
Taking drugs
Smoking
Unnecessary shopping
Computer games/console games
Social media
Talking to someone
None of the above
Other
12. What do you think that the school authorities can do to decrease the stress level?
Please share your comments
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