Survey SHS
Survey SHS
Survey SHS
Directions: Please provide the necessary information. Check the box that corresponds to your answer.
Name:________________________________________________________________Sex: Male Female
School Graduated from: _________________________________________________ Age: _____Grade Level____
Residence: ____________________________________________________________________________________
Which of the following are applicable to your living Which statement best describes your current living
situation? arrangement?
When I When I have When I have When I have When I have When I have
have a problems problems problems in problems concerns about
problem at with my with friends my romantic with myself my future
school parents interests
1. I discuss the problem with my
parents/other adults.
2. I talk about the problem
when it appears and dont
worry much.
3. I try to get help from
institutions. (school)
4. I expect the worst.
5. I accept my limits.
6. I try to talk about the
problem with the person
concerned.
7. I behave as if everything is
alright.
8. I try to let my energy out
(with loud music, riding my bike,
wild dancing, sports, etc.).
9. I do not worry because
usually everything turns out
alright
10. I think about the problem
and try to find different
solutions.
11. I compromise.
12. I let out my anger by
shouting, crying, slamming
doors, etc.
13. I tell myself that there
always be problems.
14. I only think about the
problem when it appears
15. I look for information in
magazines, internet or books.
16. I try not to think about the
problem.
17.I try to forget the problem
with alcohol or drugs
18.I try to get help and comfort
from people who are in a similar
situation.
19. I try to solve the problem
with help from my friends.
20. I withdraw because I cannot
change anything anyway.
PROBLEM QUESTIONNAIRE
On the following pages you will find a list of worries and difficulties that adolescents of your age have identified as their
problems. Probably, some are less stressful for you. Please check the items that are applicable to you.
5- Highly Stressful 4-Very stressful3- Moderately Stressful 2- Minimally Stressful 1- Not stressful at all