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Name
How are you doing?
Great
Pretty well
So-so
Not well
I'm really struggling
Elaborate, if you would like.
Where are you, and is your living situation okay?
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Yes
No
Do you have a quiet, relatively comfortable place to work?
Yes
No
Can you get quiet time to work?
Yes
No
Do you have significant extra demands on your time that would keep you from studying/working?
Yes
No
Provide a realistic assessment of your current capabilities
I can work at my usual high level
I can work, but not up to the level I usually can
I don't think I'll be able to work very much
I can't get any work done
What are your greatest fears about how we end the semester?
What can I do to support you best right now?
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