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    Sri Ganesar Higher Secondary School Panickanadaneudieruppu-628212

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    priyanka
    This document is a questionnaire on student wellbeing from SRI GANESAR HIGHER SECONDARY SCHOOL. It collects socio-demographic data on the student and asks questions about their sleep, appetite, mood, concentration, fatigue, interests, fears, thoughts, relationships, and history of psychological/medical issues to assess their wellbeing and determine if they need counseling support.

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    Sri Ganesar Higher Secondary School Panickanadaneudieruppu-628212

    Uploaded by

    priyanka
    19 views2 pages
    This document is a questionnaire on student wellbeing from SRI GANESAR HIGHER SECONDARY SCHOOL. It collects socio-demographic data on the student and asks questions about their sleep, appetite, mood, concentration, fatigue, interests, fears, thoughts, relationships, and history of psychological/medical issues to assess their wellbeing and determine if they need counseling support.

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    ASSESMENT SCALE.docx

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    This document is a questionnaire on student wellbeing from SRI GANESAR HIGHER SECONDARY SCHOOL. It collects socio-demographic data on the student and asks questions about their sleep, appetite, mood, concentration, fatigue, interests, fears, thoughts, relationships, and history of psychological/medical issues to assess their wellbeing and determine if they need counseling support.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    19 views2 pages

    Sri Ganesar Higher Secondary School Panickanadaneudieruppu-628212

    Uploaded by

    priyanka
    This document is a questionnaire on student wellbeing from SRI GANESAR HIGHER SECONDARY SCHOOL. It collects socio-demographic data on the student and asks questions about their sleep, appetite, mood, concentration, fatigue, interests, fears, thoughts, relationships, and history of psychological/medical issues to assess their wellbeing and determine if they need counseling support.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    SRI GANESAR HIGHER SECONDARY SCHOOL

    PANICKANADANEUDIERUPPU-628212

    QUESTIONNAIRE ON STUDENT WELLBEING

    (CONFIDENTAL)

    I. SOCIO -DEMOGRAPHIC DATA -DATE:

    STUDENT NAME -

    FATHER NAME -

    MOTHER NAME -

    ADDRESS -

    STANDARD & SECTION –

    MEDIUM ( TM / EM )

    HOSTLER / DAYS SCHOLAR

    SEX -

    DOB & AGE -

    CLASS TEACHER NAME -

    II AT PRESENT OR IN THE LAST 1 MONTH ANY MAJOR STRESS (IN 3 SENTENCES) –DO
    NOT ELABORATE

    III IN GENERAL,OVER LAST 3 MONTHS (TICK YOUR CHOICE)

    1. SLEEP: NO OF HOURS SLEEP IN AN AVERAGE DAY: LESS THAN 4 HOURS/4-6 HOURS /


    6-8 HOURS / MORE THAN 8 HOURS

    2. ANY APPETITE LOSS : YES/NO

    3. DIFFICULTLY IN CONCENTRATION: YES / NO


    4. MOOD STATE : LOW/ANXIOUS/ELEVATED /NORMAL

    5. ANY FATIGUE /TIREDNESS/LOW ENERGY LEVEL

    6. LACK OF INTREST IN STUDY : YES /NO

    7. ANY FEAR/INSECURITY/LOW SELF CONFIDENCE

    8. ANY UNUSUAL THOUGHTS : YES/NO

    9. ANY OTHER PROBLEM : YES/NO

    IV ANY PAST HISTORY OF PSYCHOLOGICAL PROBLEM : YES/NO

    ANY PAST HISTORY OF MEDICAL PROBLEMS: DIABETES /


    DENGUE/JAUNDICE/ANY SURGERY/ANY OTHER SPECIFY

    FAMILY HISTORY OF PSYCHOLOGICAL PROBLEM IN PARENTS, GRANDPARENTS,


    BROTHER/SISTER:

    V RELATIONSHIP WITH PARENTS: GOOD/BAD/NORMAL

    RELATIONSHIP WITH CHILDREN: GOOD/BAD/NORMAL

    RELATIONSHIP WITH COLLEAGUES: GOOD/BAD/NORMAL

    RELATIONSHIP WITH FRIENDS: GOOD/BAD/NORMAL

    RELATIONSHIP WITH TEACHERS: GOOD/BAD/NORMAL

    RELATIONSHIP WITH OTHER: GOOD/BAD/NORMAL

    VI DO YOU NEED TO TAKE A BREAK/CHANGE OF SCHOOL : YES/NO

    DO YOU FEEL A NEED TO TALK COUNSELLER: YES/NO

    SEEN BY

    (PSYCHOLOGIST)

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