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Life Balance for Teens

Total questions: 10

Worksheet time: 7mins

Name
Class
Date
1.

Do you eat breakfast?

a)

Never

b)

Sometimes

c)

Most days

d)

Yes, everyday.

2.

in a TYPICAL day, how much time do you spend on LEISURE video/internet/gaming activities? (Do not count school work.)

a)

1 hour or less

b)

more than 1 and less than 2 hours

c)

2 or more and less than 3 hours

d)

3 or more hours

3.

In a TYPICAL day, how many servings of fruits or vegetables do you eat.

a)

0 - none

b)

1-2

c)

3-4

d)

5 or more

4.

How much time do you spend on school days completing homework (completing worksheets, reading assignments, completing projects or activities)?

a)

I rarely do homework

b)

less than 30 minutes

c)

30 minutes to one hour

d)

between 1-2 hours

e)

more than 2 hours

5.

What do you do when something (or someone) is bothering you?

a)

I get really upset sometimes.

b)

I just keep it to myself.

c)

I talk to a friend.

d)

I talk to an adult.

6.

How many days each week do you engage in sustained physical exercise of 30 minutes or more?

a)

0 - none

b)

1-2

c)

3-4

d)

5-7

7.

On nights before school days, how much sleep do you usual get?

a)

less than 5 hours

b)

5-6 hours

c)

6-7 hours

d)

8 hours or more

8.

How would you describe your STUDY habits? Study habits include reviewing notes or reading assignments, quizzing yourself or with study partners, & other methods used to remember information for tests or quizzes.

a)

I never really study.

b)

I study only if I have a test the next day.

c)

I study most school days.

d)

I study at least one hour most school days.

9.

How many times each month do you participate in sports games or recreational exercise that lasts an hour or more?

a)

0 - never

b)

at least once each month

c)

2-3 times per month

d)

4 or more times per month.

10.

When I am angry, I ....

a)

keep it to myself

b)

I sometimes yell at people.

c)

I throw things.

d)

I talk to someone about it.

e)

I do things to calm down like deep breathing, exercising, or thinking about something pleasant.