SCAR-ED Screening Questionnaire
Please complete this screening questionnaire to help us better understand your current experiences and behaviors.
Full Name
*
First Name
Last Name
Age
*
Gender
*
Male
Female
Other
Prefer not to say
School/Institution Name
Class/Grade
Please indicate how often you experience the following behaviors or feelings:
*
Rows
Never
Rarely
Sometimes
Often
Always
I have trouble paying attention in class.
1
2
3
4
5
I feel anxious or worried frequently.
6
7
8
9
10
I avoid participating in group activities.
11
12
13
14
15
I get easily frustrated or upset.
16
17
18
19
20
I have difficulty completing assignments.
21
22
23
24
25
How would you rate your overall mood in the past two weeks?
*
1
2
3
4
5
Have you noticed any recent changes in your sleep patterns?
*
No change
Sleeping more than usual
Sleeping less than usual
Do you frequently feel isolated from others?
*
Yes
No
Sometimes
Is there anything else you would like to share about your recent experiences?
Signature
*
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