Student Resilience Treatment Selection Survey
Please complete this survey to help us understand your resilience and preferences for support or treatment options.
Full Name
*
First Name
Last Name
Age
*
Gender
Male
Female
Non-binary
Prefer not to say
Other
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Resilience Assessment: Please indicate how much you agree with each statement.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I am able to adapt to change.
1
2
3
4
5
I can deal with whatever comes my way.
6
7
8
9
10
I try to see the humorous side of things.
11
12
13
14
15
I tend to bounce back after illness or hardship.
16
17
18
19
20
I believe I can achieve my goals, even if there are obstacles.
21
22
23
24
25
Have you previously participated in any resilience or mental health support programs?
*
Yes
No
If yes, please specify the type of support or treatment you received.
Which types of support or treatment are you interested in? (Select all that apply)
*
Individual counseling
Group therapy
Workshops or seminars
Peer support groups
Online resources or self-help
Other
How likely are you to participate in a resilience treatment program if offered?
*
Not likely
1
2
3
4
Very likely
5
1 is Not likely, 5 is Very likely
What barriers might prevent you from participating in a treatment or support program? (Select all that apply)
Lack of time
Cost
Stigma or embarrassment
Unaware of available options
Other
Please share any additional comments or suggestions regarding resilience support or treatment options.
Submit Survey
Should be Empty: