Executive Functioning Skills Evaluation for High School Students
Dear Student,

This questionnaire is designed to help you understand and improve your
executive functioning skills. Please answer the following questions honestly to
get the most benefit.
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STUDENT INFORMATION:
Student's Name:
 *
Student's Age *
Contact Information (Phone):
 *
Contact Information (Email):
 *
Student's Grade Level: *
School Name: *
PLANNING SKILLS
This section delves into your ability to organize tasks and prioritize them effectively. Questions explore your reliance on tools like planners or calendars, your approach to managing large tasks, and your tendencies regarding task completion timelines.
How often do you use a planner or calendar to organize your tasks?
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Do you often find yourself missing deadlines for assignments or projects?
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When given a large task, how do you usually approach it?
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ORGANIZATION SKILLS
Examines the orderliness of your personal spaces and your ability to keep track of essential items.
Rate the organization of your personal spaces (desk, backpack, bedroom) from 1 (very disorganized) to 5 (very organized).
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How often do you lose important papers or notes?
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Describe your method of note-taking and organizing school materials.
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PRIORITIZATION SKILLS
Looks into how you determine which tasks to tackle first and how you manage competing priorities.
When you have multiple tasks, how do you decide which one to do first?
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Do you often find yourself doing more enjoyable activities instead of important tasks?
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Have you missed out on completing important tasks because you chose to do something else? Provide an example.
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FOCUS, ATTENTION, CONCENTRATION SKILLS
Evaluates your ability to maintain concentration on tasks and handle distractions.
How easily do you get distracted when working on a task?
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Describe a situation where you had difficulty concentrating and what you think caused it.
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What strategies, if any, do you use to maintain focus?
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INHIBITORY SKILLS
Assesses your capacity to control impulses and stay focused amid distractions.
Do you find it challenging to resist distractions?
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How often do you act without thinking and later regret it?
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Give an example of a time when you were able to control an impulsive decision.
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TASK INITIATION SKILLS
Examines how promptly you begin tasks and the factors that drive you to start them.
How long does it typically take for you to start a task after planning to do it?
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Do you often feel stuck and unsure of how to start a task?
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What motivates you to begin a task, especially one you are not interested in?
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Required
TASK PERSISTENCE SKILLS
Looks at your consistency in completing tasks and any challenges you face in finishing them.
Do you often start tasks but fail to complete them?
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What are the common reasons you stop working on a task?
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Required
How do you motivate yourself to continue with a challenging or uninteresting task?
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Required
TRANSITION SKILLS
Evaluates your adaptability to changes in routines and how you manage transitions between activities.
How do you handle changes in your daily routine or unexpected transitions?
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Do you often find yourself late or unprepared for transitions between activities?
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What strategies could help you manage transitions more effectively?
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WORKING MEMORY SKILLS
Assesses your ability to retain and manage information while working on tasks.
Do you often forget instructions or steps in a process?
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How do you keep track of multiple pieces of information when working on a task?
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Required
Have you developed any strategies to improve your memory? Please explain.
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EMOTIONAL REGULATION SKILLS
Examines how you manage your emotions, particularly in stressful or challenging situations.
How do you typically handle stressful or challenging situations?
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Describe a time when your emotions affected your ability to complete a task.
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What techniques do you use to manage your emotions?
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Required
METACOGNITIVE SKILLS
Looks at your self-awareness regarding learning methods, mistakes, and work quality assessment.
How often do you reflect on your learning and working methods?
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Do you find it easy to recognize and learn from your mistakes?
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How do you assess the quality of your work?
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Required
SKILLS TO MOVE THROUGH RESISTANCE
Examines your strategies for handling tasks you find challenging or unappealing and how you address procrastination.
When faced with a task you don't want to do, how do you usually respond?
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Required
Have you found any effective ways to overcome resistance or procrastination? Please describe.
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What support or resources do you think would help you in dealing with resistance?
 *

Thank you for completing the Executive Functioning Skills Assessment Questionnaire with Themba Tutors. Your insightful responses are crucial in helping us understand your unique strengths and areas for improvement. Our dedicated team at Themba Tutors will meticulously review your feedback to provide you with personalized strategies and resources. Your commitment to personal growth and self-awareness is commendable, and we're genuinely excited to accompany you on this transformative journey. Rest assured, we are here to support you every step of the way. Your time and effort are greatly valued, and we look forward to empowering you to achieve your goals!

Warm regards,
The Themba Tutors Team

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