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Age:
 
14
 
15
 
16
 
17
 
18
 
 
 
Grade:
 
9th
 
10th
 
11th
 
12th
 
 
 
on average how many hours do you sleep on a school night?
 
less than 3
 
4-5
 
5-6
 
6-7
 
7-8
 
 
 
What is the main reason you stay up at night
 
Homework
 
Boyfriend/Girlfriend
 
Cant sleep
 
other
 
 
 
On average how many hours of homework do you have a night?
 
30min
 
an hour
 
two hours
 
3+ hours
 
 
 
Do you find yourself falling asleep in school
 
always
 
often
 
sometimes
 
never
 
 
 
Do you feel more stressed in school if you get less sleep?
   
 
 
 
If you're feeling stressed do you also feel unmotivated?