1. Age: years
2. Gender: Male Female
3. Year in College:
4. Ethnicity:
5. Residence: On Campus Off Campus
6. Estimated GPA:
7. Who did you live with during high school? Both Parents Mother Father Relative Adoptive Other
8. Do you have any siblings? (biological, adopted, or family members considered siblings) Yes No 8a. If so, how many siblings do you have:
"Parents" in the next set of questions refer to your legal guardians when you were in high school.
1. What is your mother's highest level of education? Junior High High School Some College Associates Degree Bachelors Higher
2. What is your father's highest level of education? Junior High High School Some College Associates Degree Bachelors Higher
3. How often do you talk to your parents? Not Often Very Often
4. How likely are you to seek advice from your parents about life stressors? Not Likely Very Likely
5. How supportive were your parents of your decision to go to college? Not Supportive Very Supportive
6. How supportive are your parents of your post- graduation plans (i.e. grad school, career, etc.)? Not Supportive Very Supportive
7. How supportive are your parents in regard to finances? Not Supportive Very Supportive
8. How supportive are your parents in regard to emotional support? Not Supportive Very Supportive
"Siblings" in the next set set of questions refer to who you consider your sibling, biological, adoptive, etc.
1. Have you had any siblings attend college? None Some Most All Not Applicable
2. Have you had any siblings graduate college? None Some Most All Not Applicable
3. How often do you seek advice from your siblings? Not Often Not Applicable
4. How supportive were your siblings of your decision to go to college? Not Supportive Not Applicable
5. How supportive are your siblings of your post-graduation plans (i.e. grad school, career, etc.)? Not Supportive Not Applicable
6. How supportive are your siblings in regard to emotional support? Not Supportive Not Applicable
"Friends" in the next set of questions refer to your high school friends not college friends.
1. Have you had any friends attend college? None Some Most All Not Applicable
2. Have you had any friends graduate college? None Some Most All Not Applicable
3. How often do you seek advice from your friends? Not Often Very Often
4. How supportive were your friends of your decision to go to college? Not Supportive Very Supportive
5. How supportive are your friends of your post- graduation plans (i.e. grad school, career, etc.)? Not Supportive Very Supportive
6. How supportive are your friends in regard to emotional support? Not Supportive Very Supportive
Please answer the next questions to the best of your ability.
1. How much of your financial obligations (i.e. tuition, books, food, living costs, etc.) do your parents pay for? 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
2. How comfortable do you feel asking your parents for money? Not Comfortable Very Comfortable
3. Are you employed?Yes No
4. If yes, where do you work? On Campus Off Campus Both
5. If yes, how many hours do you work?
6. Approximately how much will you personally have taken out in loans by the end of the current academic year? $0 - $5,000 $5,001 - $10,000 $10,001 - $20,000 $20,001 - $30,000 $30,001+
7. How much money have you received in scholarships and loans (per year)? $0 - $5,000 $5,001 - $10,000 $10,001 - $20,000 $20,001 - $30,000 $30,001+
Please identify a point on the continuum that best represents how the statement applies to you.
1. I feel that I fit in well as part of the college environment. Applies Very Closely to Me Doesn't Apply at All
2. I have been feeling tense or nervous lately. Applies Very Closely to Me Doesn't Apply at All
3. I am meeting as many people, and making as many friends as I would like at college. Applies Very Closely to Me Doesn't Apply at All
4. Lately I have been feeling blue and moody a lot. Applies Very Closely to Me Doesn't Apply at All
5. I am very involved with social activities in college. Applies Very Closely to Me Doesn't Apply at All
6. I am adjusting well to college. Applies Very Closely to Me Doesn't Apply at All
7. I have felt tired much of the time lately. Applies Very Closely to Me Doesn't Apply at All
8. Being on my own, taking responsibility for myself, has not been easy. Applies Very Closely to Me Doesn't Apply at All
9. I have had informal, personal contacts with college professors. Applies Very Closely to Me Doesn't Apply at All
10. I am pleased now about my decision to attend this college in particular. Applies Very Closely to Me Doesn't Apply at All
11. I have several close social ties at college. Applies Very Closely to Me Doesn't Apply at All
12. I haven't been able to control my emotions very well lately. Applies Very Closely to Me Doesn't Apply at All
13. Lonesomeness for home is a source of difficulty for me now. Applies Very Closely to Me Doesn't Apply at All
14. My appetite has been good lately. Applies Very Closely to Me Doesn't Apply at All
15. I enjoy living in a college dormitory. (Please omit if you do not live in a dormitory; any college housing should be regarded as a dormitory.) Applies Very Closely to Me Doesn't Apply at All
16. I have been having a lot of headaches lately. Applies Very Closely to Me Doesn't Apply at All
17. I am satisfied with the extracurricular activities available at college. Applies Very Closely to Me Doesn't Apply at All
18. I've given a lot of thought lately to whether I should ask for help from the Psychological/Counseling Services Center or from a psychotherapist outside of college. Applies Very Closely to Me Doesn't Apply at All
19. I am getting along very well with my roommate(s) at college. (Please omit if you do not have a roommate.) Applies Very Closely to Me Doesn't Apply at All
20. I've put on (or lost) too much weight recently. Applies Very Closely to Me Doesn't Apply at All
21. I feel that I have enough social skills to get along well in the college setting. Applies Very Closely to Me Doesn't Apply at All
22. I have been getting angry too easily lately. Applies Very Closely to Me Doesn't Apply at All
23. I haven't been sleeping very well. Applies Very Closely to Me Doesn't Apply at All
24. I am having difficulty feeling at ease with other people at college. Applies Very Closely to Me Doesn't Apply at All
25. Sometimes my thinking gets muddled up too easily. Applies Very Closely to Me Doesn't Apply at All
26. I am satisfied with the extent to which I am participating in social activities at college. Applies Very Closely to Me Doesn't Apply at All
27. I haven't been mixing too well with the opposite sex lately. Applies Very Closely to Me Doesn't Apply at All
28. I worry a lot about my college expenses. Applies Very Closely to Me Doesn't Apply at All
29. I have been feeling lonely a lot at college lately. Applies Very Closely to Me Doesn't Apply at All
30. I have been feeling in good health lately. Applies Very Closely to Me Doesn't Apply at All
31. I feel I am very different from other students at college in ways that I don't like. Applies Very Closely to Me Doesn't Apply at All
32. On balance, I would rather be home than here. Applies Very Closely to Me Doesn't Apply at All
33. I have some good friends or acquaintances at college with whom I can talk about any problems I may have. Applies Very Closely to Me Doesn't Apply at All
34. I am experiencing a lot of difficulty coping with the stresses imposed on me in college. Applies Very Closely to Me Doesn't Apply at All
35. I am quite satisfied with my social life at college. Applies Very Closely to Me Doesn't Apply at All
Please check your answers. When you are done, push the button below.