Student Mental Wellness Self-Report
Student Name
Date
1. How are you feeling today?
Very Good
Good
Okay
Not Great
Bad
2. Can you briefly describe why you feel this way?
3. Have you experienced any stress or challenges recently? (If so, please describe)
4. What strategies or activities help you feel better or manage stress?
5. Would you like to talk to someone about your mental wellness?
Yes
No
Maybe