Stress Snapshot Survey

Please answer the following questions honestly. For questions 1–3, circle the number that best represents your experience. For questions 4–6, write your responses in the space provided.

1. Right now, how stressed do you feel?

   1 2 3 4 5
   
   
   

2. Over the past week, how often have you felt overwhelmed by schoolwork or other tasks?

   1 (Never) 2 3 4 5 (Always)
   
   
   

3. Rate how much you agree with each statement (1 = Strongly Disagree, 5 = Strongly Agree):

   a. I have trouble concentrating when I’m stressed. 1 2 3 4 5
   b. I notice physical signs (e.g., tight muscles) when I’m stressed. 1 2 3 4 5
   c. I feel I have enough ways to calm myself down. 1 2 3 4 5
   
   
   

4. What are the top two things causing you stress right now?

   • ________________________________________________________
   • ________________________________________________________
   
   
   
   
   
   

5. When you notice stress in your body, what do you feel? (e.g., racing heart, tummy aches, tense shoulders)

   ---

   ________________________________________________________________
   
   
   
   
   
   

6. What is one activity or strategy you think could help you calm down when you’re stressed? (e.g., deep breathing, taking a walk)

   ---

   ________________________________________________________________
   
   
   
   
   
   

Thank you for being honest! Your answers will help us create a plan just for you.

Coping Strategy Brainstorm Journal

In this journal, you will brainstorm different ways to help you feel calm and in control when you notice stress. Think of strategies you already know or new ideas you’d like to try.

1. Physical Strategies

(These use your body to help you relax or get energy.)
• ________________________________________________________



• ________________________________________________________



• ________________________________________________________

2. Emotional Strategies

(These help you change or express how you feel.)
• ________________________________________________________



• ________________________________________________________



• ________________________________________________________

3. Social Strategies

(These involve connecting with others for support or fun.)
• ________________________________________________________



• ________________________________________________________



• ________________________________________________________

4. Cognitive Strategies

(These help you change your thoughts or focus your mind.)
• ________________________________________________________



• ________________________________________________________



• ________________________________________________________

Reflection:

Which strategy are you most excited to try and why?

Self-Regulation Growth Rubric

Use this rubric to track progress in noticing stress signals, choosing and using coping strategies, and reflecting on their effectiveness.

Scoring Guide:
• 1 (Beginning): Needs significant support to notice stress and apply strategies.
• 2 (Developing): Shows emerging skills with prompting and guidance.
• 3 (Proficient): Independently practices most skills with consistency.
• 4 (Advanced): Demonstrates autonomy, insight, and continuous improvement.

One-on-One Reflection Guide

Use this guide to close your individualized session. Encourage the student to think deeply about their experiences, successes, and next steps. Provide a safe, supportive space and remind them that there are no “right” or “wrong” answers.

Discussion Guidelines

• Speak in a calm, non-judgmental tone.
• Allow the student time to think and respond.
• Offer prompts if they get stuck, but let them lead the reflection.
• Refer to their own work (Stress Snapshot Survey, Coping Strategy Brainstorm Journal, Self-Regulation Growth Rubric).

Reflection Questions

1. Noticing Your Stress

• What did you learn about your stress level from the Stress Snapshot Survey?

Follow-up:

• How did your body feel when you noticed stress?
• When were you surprised by how stressed (or calm) you felt?

2. Understanding Triggers

• Which two stressors did you identify as most challenging?

Follow-up:

• Can you think of a recent moment when one of these showed up?
• What thoughts or feelings came first?

3. Evaluating Your Strategies

• From your Coping Strategy Brainstorm Journal, which strategy are you most excited to try or have already tried?

Follow-up:

• How did it feel before, during, and after you tried it?
• What worked well? What felt tricky?

4. Growth and Next Steps

• Looking at the Self-Regulation Growth Rubric, which skill (e.g., recognizing signals, selecting strategies, reflecting) do you want to focus on improving this week?

Follow-up:

• What specific action will you take when you notice stress building?
• How will you remind yourself to use your Personal Pulse Plan?

Closing Prompt:
"What is one thing you feel proud of from today’s session?"

Thank you for sharing! I’m proud of the steps you’re taking to understand and manage your stress.