Student Wellbeing Check-In template

A short wellbeing check-in for students: how the week went on a 1–10 scale, a five-row matrix on sleep, schoolwork, feeling included, having someone to talk to, and being able to focus, what has been hardest lately, and whether they would like someone to reach out. The name field is optional, and asking for a check-in reveals a question about how to reach them.

Use this template Start free — no card

11 questions · works on the free plan (500 responses/month) · fully customizable

1 built-in logic rule

What’s inside

The questions this template ships with — rename, reorder, or delete any of them in the builder.

01Your nameShort text

02Your gradeDropdown

03How has this week been overall?Rating scale

04How often has each of these been true this week?Matrix

05What has been hardest lately?Checkboxes

06Is there anything you would like a teacher to know?Long text

07Would you like someone to check in with you?Multiple choice

08How should we reach you?Short text

09If you need help right nowStatement

When to use this template

A pastoral or wellbeing team running a weekly pulse across a year group
A homeroom teacher checking in with a class after a difficult term or a disruptive event
A counselor who needs a low-friction way for students to ask for a conversation without walking into an office
A school measuring whether a wellbeing program is changing anything, by comparing matrix scores across rounds

Tips to get more from it

If you run this as an anonymous climate pulse rather than a named check-in, turn on anonymous responses in the form's settings and remove the name field. That setting means no IP address, user agent, referrer, geolocation, browser language, or screen size is stored, and those are stripped from partially completed rows too — so a student who starts the form and closes it leaves nothing identifying behind. Answers, timing, and tags are still recorded.
The check-in request drives the skip rule: students who say they are okay never see the how-should-we-reach-you question, and the two "yes" options let a student flag urgency without having to explain it.
Keep the closing statement about getting help right now. Naming the limits of the form — that it is read during school hours only — is the honest thing to do, and a student in crisis needs the alternative in front of them.
Read the matrix as a trend, not a score. "I have had someone to talk to" drifting from Often to Sometimes across a year group is the finding that matters, and it only shows up if you run the same rows every time.

Questions people ask

Can students respond anonymously?

The name field is optional, so a student can leave it blank and still ask for support. For a genuinely anonymous pulse, turn on the anonymous responses setting: no IP address, user agent, referrer, geolocation, browser language, or screen size is stored, on completed or partial rows.

Is this a substitute for a counselor?

No. It is an intake and a trend line, not a clinical tool and not a crisis channel. The template says so on its closing screen, and Zunoform holds no HIPAA BAA — do not use it to store clinical notes or treat it as a monitored support line.

How often should we run a wellbeing check-in?

Weekly or fortnightly works for most pastoral teams — frequent enough to catch a change, rare enough that students keep answering honestly. Duplicate the form per round so each cycle's responses stay separate and comparable.

Is this template free to run?

Yes. Rating, matrix, multi-select, and statement fields all publish on the free plan, which covers 500 responses per month. A year group of 200 checking in weekly needs Pro at $14.99/mo for its 5,000 responses.