What is your Teacher's name? *

School Name: *

Sometimes, everyone worries about something. Can you tell us a little about what worries you?
I never worry I sometimes worry I worry a lot
Making friends
Being late for school
Getting good grades
Being bullied
Being offered drugs
Being invoved in a gang
Staying safe online
Having good relationships with people who are important to me
Going to junior high next year
Not fitting in
Staying fit and healthy
Having a place to live

Making friends

Being late for school

Getting good grades

Being bullied

Being offered drugs

Being invoved in a gang

Staying safe online

Having good relationships with people who are important to me

Going to junior high next year

Not fitting in

Staying fit and healthy

Having a place to live

When online, what sites or apps do you use most? (where do you spend the most time...gaming, talking to friends, streaming, etc.)

I feel confident that I know how to say "no" or know what to do when offered or pressured to try drugs or alcohol.

I trust the police.

I would feel comfortable approaching a police officer and asking for help.

I feel confident in my ability to make smart and positive choices in life.

I feel comfortable asking for help and accessing resources and supports if I need them.

I know a great deal about staying safe online.

I know a great deal about staying safe when it comes to drugs.

I know a great deal about staying safe when it comes to gangs.

I know a great deal about having healthy relationships with others.

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