SMILING FACES

G

O ING PLAC E S

Please answer the following questions as best you can.1. About you: Age______ Grade______

2. In your own words, describe what you think mental health is?

3. Who do you talk to when you are having a bad day? [ ] My family [ ] My school counselor or teacher [ ] My friends [ ] Other ____________________

4. How did you find out about tonight’s event? [ ] I received a flier at school [ ] I heard about it on the radio [ ] My parents told me about it [ ] Other __________________

Read the following story to answer questions 3 & 4

Jane Smith is a girl in your class. She is very quiet and does not play with other children at recess. She usually sits by herself at lunch. Jane does not have many friends and doesnt hang out with many of the people in your class.

4. Compared to other children in your class, do you think Jane is- (check all that apply) [ ] Lazier [ ] More Violent [ ] Smarter [ ] More Troublesome [ ] None of the above

5. How do you and your classmates treat Jane during school? (check all that apply) [ ] Say mean things to her or calls her names [ ] Don’t invite Jane to parties [ ] Invite her to sit at your table for lunch [ ] Ask her to play with you at recess [ ] Make fun of Jane when she’s not around [ ] Other______________________