What is your age? Name First Last 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 UntitledDo you ever use it?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 12. List two strategies to help people get more sleep?