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Students Survey

Please complete the form below. Mandatory fields marked *


1. Which grade are you in? 9th Grade 10th Grade 11th Grade 12th Grade

2. How much do you agree or disagree with the following statements about your school?

 Strongly Agree Agree Disagree Strongly Disagree
a. I feel welcome in my school.
b. Most of the adults I see at school every day know my name or who I am.
c. The adults at my school look out for me.

3. How much do you agree or disagree with the following statements about being successful at your school?

 Strongly Agree Agree Disagree Strongly Disagree
a. The adults at my school help me understand what I need to do to
succeed in school.
b. My teachers encourage me to succeed.
c. I need to work hard to get good grades at my school.
d. Students who get good grades in my school are respected by other students.
e. Someone in my school helps me develop challenging goals for learning more in school.
f. Someone at my school helps me understand what courses I need to be promoted to the next grade or graduate.
g. My teachers expect me to continue my education after high school.
h. My high school provides helpful counseling on how to get a good job
after high school or how to get into college.

4. On a scale of 1 to 4, how comfortable are you talking to teachers and other adults at your school

Uncomfortable
1
2
3		 Comfortable
4
a. a problem you are having in a class?
b. something that is bothering you?
c. something outside of school that is important to you?

5. On a scale of 1 to 4, how available are teachers and other adults at your school to talk about:

Unavailable
1
2
3		 Available
4
a. a problem you are having in a class?
b. something that is bothering you?
c. something outside of school that is important to you?

6. How much do you agree or disagree with the following statements about your teachers?

 Strongly Agree Agree Disagree Strongly Disagree Don't Know
a. Teachers in my school treat students with respect.
b. Most students in my school treat teachers with respect.
c. Adults in my school treat each other with respect.
d. My teachers enjoy the subjects they teach.
e. My teachers inspire me to learn.
f. My teachers give me extra help when I need it.
g. My teachers connect what I am learning to life outside of the classroom.

7. How often, during this school year, have your teachers asked you to

 Never
1 or 2
times		 3 or 4
times		 5 or
more
times
a. Complete an essay or research project using multiple sources of information?
b. Complete an essay or project where you had to use evidence to defend your own opinion or ideas?

8. In how many of your classes during the past two weeks have you:

 None of
My
Classes		 One of
My
Classes		 Some of
My
Classes		 Most of
My
Classes		 All of My
Classes
a. worked by yourself (independently) during class?
b. worked in groups of 2 to 6 students?
c. had whole-class discussions?
d. participated in hands-on

9. During this school year, have you taken or had a chance to take a class in the following subjects?

 I took one or more classes in this subject I was offered
but did not
take a class in this subject		 I was NOT
offered a
class in this
subject
a. Art
b. Music
c. Dance
d. Theater
e. Foreign language
f. Computer skills/technology
g. Health
h. Physical education

10. During this school year, which of the following activities did you participate in either before or after school or during free periods?

 I participated in this activity

 I did not
participate in this activity
although it
was offered		 I was NOT
offered this
activity
a. Art
b. Music
c. Dance
d. Theater
e. Foreign language
f. Computer skills/technology
g. School sports teams or clubs
h. Tutoring/enrichment activities
11. How much do you agree or disagree with the following statement? Strongly Agree Agree Disagree Strongly Disagree
My school offers a wide enough variety of classes and activities to keep me interested in school.

12. How much do you agree or disagree with the following
statements about students in your school?

 Strongly Agree Agree Disagree Strongly Disagree
a. Most students in my school help and care about each other.
b. Most students in my school just look out for themselves.
c. Most students in my school treat each other with respect.
d. Most students in my school like to put others down.

13. How often are the following things true about
you or about your school?

 Never Some of the Time Most of the Time All of the
Time
a. I worry about crime and violence in school.
b. I stay home because I don�t feel safe at school.
c. Students threaten or bully other students at school.
d. Students get into physical fights at my school.
e. Adults at my school yell at students.
f. There is conflict in my school based on: race, culture,
religion, sexual orientation, gender, or disabilities.
g. Students use alcohol or illegal drugs while at school.
h. There is gang activity at my school.

14. How much do you agree or disagree with the
following statements about your school?

 Strongly Agree Agree Disagree Strongly Disagree
a. There is a person or program in my school to help students resolve conflicts.
b. Discipline in my school is fair.
c. I am safe in my classes.
d. I am safe in the hallways, bathrooms, and locker rooms at my school.
e. I am safe on school property outside my school building.
f. The presence and actions of School Safety Agents help to promote a safe and respectful learning environment.
g. My school is kept clean.
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