Gysbers Elementary Student Counseling Survey

Date: ________________ Grade (circle): 3 4 5 Read each sentence. Circle ONE answer that describes what is true for you. 1. I am successful at school. Always Sometimes 2. When I do well in school, I feel proud. Always Sometimes 3. I turn my homework in on time. Always Sometimes 4. I ask for help at school when I need it. Always Sometimes

Not usually

Never

Not usually

Never

Not usually

Never

Not usually

Never

5. I choose to have good behavior when I am at school. Always Sometimes Not usually 6. I learn from my mistakes. Always Sometimes

Never

Not usually

Never

7. I share what I have learned with other students. Always Sometimes Not usually

Never

8. I like to find out more about something interesting I learned at school. Always Sometimes Not usually Never 9. I decide what grades I want to earn and make a plan on how to earn those grades. Always Sometimes Not usually Never 10. After school I finish my assignments and still have time to do other things I like to do. Always Sometimes Not usually Never 11. I know what I can do well. Always Sometimes

Not usually

Never

12. It is okay for others to act and think in a different way than I do. Always Sometimes Not usually

Never

13. The things I learn at school will help me with the job I do when I grow up. Always Sometimes Not usually Never 14. I like myself. Always

Sometimes

Not usually

Never

15. I know the difference between good behavior and bad behavior. Always Sometimes Not usually 16. I get along well with family and students. Always Sometimes 17. I work well with other students in teams. Always Sometimes

Never

Not usually

Never

Not usually

Never

18. Before I solve a problem, I think about what will happen. Always Sometimes Not usually 19. I know how to set goals for myself. Always Sometimes 20. I can make and keep friends. Always Sometimes

Never

Not usually

Never

Not usually

Never

21. I do what I think is right even if my friends say I should do something else. Always Sometimes Not usually Never 22. I understand and follow rules set by my school, my family, and the law. Always Sometimes Not usually Never 23. When bad things happen in my life I know what to do to make them better. Always Sometimes Not usually Never 24. I understand that my interests and skills will help me do well in the job I do when I grow up. Always Sometimes Not usually Never 25. I can tell friends and family what I feel or need. Always Sometimes Not usually

Never