What is your age? Name First Last What school do you attend? Would you recommend this program to another student? Yes Maybe No 1. Do you know how to take breaks that give you more energy and help calm emotions? a. Almost all the time b. Often c. Sometimes d. Not very much e. Almost never 2. In the last week, when you took a break or had some down time, what did you do? Choose all that apply. a. Social media b. TV, Netflix, Disney Plus, Hulu, etc. c. Texting b. Gaming e. Listened to music f. Read g. Spent time outside h. Exercised i. Took a nap j. Talked with someone k. Journaled 3. Do you work hard to have relationships that are authentic (authentic means being honest about your thoughts, feelings, and experiences with someone – removing your mask)? a. Almost all the time b. Often c. Sometimes d. Not very much e. Almost never 4. How often do you intentionally put down technology to connect with others and examine what is going on inside of you? a. Daily b. Twice a week c. Weekly d. Monthly e. Almost never 5. Do you have healthy boundaries in relationships? a. I don’t know what healthy boundaries are b. Yes c. Somewhat d. No 6. Do you know what Cortisol Overload does to your body?? a. Yes b. No 7. List two things that reduce the negative effects of cortisol overload8. Do you know how to use deep breathing to calm yourself down? a. Yes b. No 9. How often do you spend examining what emotions are going on within you? a. Throughout the day b. Once a day c. Weekly d. Monthly e. Almost never 10. On average, how many hours of sleep do you get a night? a. Less than 4 b. 4-5 c. 6-7 d. 8-9 e. 9 or more 11. List two strategies to help people get more sleep?12. Use 1-3 words to describe Run the Race?13. What two things did you learn that were the most valuable for you?14. What information from Run the Race would you want to share with a friend?15. Did the message of Restorative Wellness from Run the Race give you ideas on how to refill your cup? Yes Somewhat A little No 17. Do you think this message is helpful for students today? Yes! Somewhat A little No Δ
