Pulse Check Interview Form
Pulse Check
A private interview for growth and understanding
Name
Date
This interview is a way for me to get to know you better. There are no right or wrong answers—just your honest thoughts and feelings. Take your time.
1
How has this school year been for you so far?
Loving it
It's okay
Struggling
2
What are three things that never fail to make you feel happy?
3
What is something that really makes you feel angry or frustrated lately?
4
What is one thing that has made you feel a bit sad or down recently?
5
When do you find yourself feeling nervous or anxious at school?
6
On a scale of 1-10, how stressed does school make you feel right now?
1: Super Chill 10: Overwhelmed
1
2
3
4
5
6
7
8
9
10
Why did you pick that number?
7
How would you describe your social life or friendships right now?
8
How are things going at home with your family? Do you feel supported?
9
If a genie granted you 3 wishes, what would they be?
10
What is one personal goal you have for yourself right now?
11
Who is one adult at school you feel comfortable talking to if you need help?
12
What is one thing you wish your teachers understood better about you?
End of Pulse Check
Heart to Heart Facilitator Guide
Facilitator Guide Middle School Grades 6-8
Heart to Heart
A guide for conducting the Pulse Check interview and building meaningful connections with your students.
Purpose
The Pulse Check interview is designed to peek behind the curtain of the "typical" middle school response. In an age where students are navigating intense social pressure and academic stress, this tool provides a safe structured space for them to share their internal world.
Best Practices
-
1
Choose your setting wisely. This should not be done during a busy class. Find a quiet corner or a separate room to ensure the student feels their words won't be overheard.
-
2
Normalize the process. Explain that you are doing this with every student to learn how to be a better teacher for them. This removes the "Am I in trouble?" anxiety.
-
3
Listen more than you talk. Avoid the urge to fix things immediately. Your primary role is to validate their feelings with phrases like "I hear you" or "That sounds like it would be tough."
Red Flags to Watch For
Isolation
Indications of no friends or a complete lack of support at home.
Extreme Stress
Physical symptoms of anxiety (shaking, inability to focus) during the school day.
Apathy
Inability to name even one thing that makes them happy or one wish.
Interview Length
10-15 Minutes
Deep Dive: The Questions
Focus: The 1-10 Stress Scale
Question 6
"Anything over a 7 should trigger a follow-up conversation about coping mechanisms. Ask: 'What does that 8 feel like in your body?' or 'What happens when you get home at that level of stress?'"
Focus: The 3 Wishes
Question 9
"Wishes reveal what is missing. If they wish for material items, they are likely feeling stable. If they wish for changes in family or physical safety, pay close attention to the emotional undercurrent."
Focus: Teacher Understanding
Question 12
"This is the most actionable question. Share this feedback (anonymously) with the student's teaching team to help create a more empathetic classroom environment for that individual."
Crucial Reminder: Mandatory Reporting
As a professional, if a student discloses self-harm, harm to others, or abuse during this interview, you are legally and ethically required to follow your school's reporting protocols immediately. Always remind the student at the beginning of the interview that while you keep things private, you must report things that involve safety.
