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Directions: You are being asked to complete this survey about your experiences at your school this school
year. Please read each item carefully and respond to each item accurately based on your experiences.
There are no wrong or right answers to this survey.
Your responses will be confidential. Your individual responses will not be reported to your parents, peers,
or any adult at your school.
I. Academic Engagement
Strongly Disagree
Strongly Agree
Disagree
Please indicate your level of agreement with the following
Agree
statements about this school year.
Strongly Agree
Disagree
Copyright 2010 the Office of the Governor, North Carolina NC SLCS was developed through a collaboration between Friday
Institute for Educational Innovation, the North Carolina Department of Public Instruction, and the Office of the Governor.
III. 21st Century Skills
Strongly Disagree
Strongly Agree
Disagree
Please indicate your level of agreement with the following
Agree
statements about this school year.
12. When I have many assignments, I am able to choose which ones need to
be done first.
13. In school, I am able to work well with students from different
backgrounds.
14. In school, I am able to work well with other students in small groups.
15. In school, I often encourage others to do their best.
16. In school, I try to produce the highest quality work I can.
17. In school, I respect the differences among my peers.
18. In school, I help my peers when I can.
Strongly Agree
Please indicate your level of agreement with the following Disagree
Agree
statements about this school year.
Copyright 2010 the Office of the Governor, North Carolina NC SLCS was developed through a collaboration between Friday
Institute for Educational Innovation, the North Carolina Department of Public Instruction, and the Office of the Governor.
V. Use of Technology for Learning
Monthly
Weekly
On average, how often do you do the following? Base your
Never
Daily
responses on your activity level this school year.
Strongly Disagree
Strongly Agree
Disagree
Please indicate your level of agreement with the following
Agree
statements about your first period teacher this school year.
Copyright 2010 the Office of the Governor, North Carolina NC SLCS was developed through a collaboration between Friday
Institute for Educational Innovation, the North Carolina Department of Public Instruction, and the Office of the Governor.
Demographics
39. Please select your gender.
A. Female
B. Male
44. I have taken a class for school online (e.g., NC Virtual Public School):
A. Yes
B. No
45. Choose the number of schools you have attended during the past 2 school years.
A. 1
B. 2
C. 3
D. more than 3
50. Choose any of the following living situations that apply to you:
A. Living in a house, condo, apartment, or trailer
B. Living in a shelter or motel
C. Living in a car, campsite, abandoned building, or on the street
Copyright 2010 the Office of the Governor, North Carolina NC SLCS was developed through a collaboration between Friday
Institute for Educational Innovation, the North Carolina Department of Public Instruction, and the Office of the Governor.