2/28/2019 Qualtrics Survey Software

English

Block 1

The following questions are about your school. Please select the answer that best represents how you feel. Remember, there are no right
or wrong answers!

My classmates show respect to each other.

I use ways to calm myself down.

My classmates show respect to other students who

are different.

I am happy with the way my classmates treat me.

Teachers at this school care about their students.

Adults at my school listen to student ideas and

opinions.

Block 2

The following questions are about your school. Please select the answer that best represents how you feel. Remember, there are no right
or wrong answers!

Adults at my school treat all students fairly.

The staff in the front office show respect to students.

It is easy for me to talk to adults at my school about

my problems.

I say "no" to friends who want me to break the rules.

I like to come to school.

At my school, there is respect for different cultures.

Block 3

The following questions are about your school. Please select the answer that best represents how you feel. Remember, there are no right
or wrong answers!

Students at my school follow the school rules.

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I feel safe at my school.

Students at my school treat teachers with respect.

At my school, there is respect for students who speak

languages other than English.

I can do even the hardest schoolwork if I try.

I enjoy doing my schoolwork.

Block 4

The following questions are about your school. Please select the answer that best represents how you feel. Remember, there are no right
or wrong answers!

I feel successful in my schoolwork.

I can reach the goals I set for myself.

My homework helps me learn things I need to know.

During my school day, I am aware of when my

feelings change.

If I get angry with a classmate, we can talk about it

and make it better.

Block 5

The following questions are about your school. Please select the answer that best represents how you feel. Remember, there are no right
or wrong answers!

My schoolwork makes me think about things in new

ways.

I have fun learning in my classes.

My teachers are fair to everyone.

At my school, I often notice how others are feeling.

My teachers connect what I am doing to my life

outside the classroom.

Block 6

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The following questions are about your school. Please select the answer that best represents how you feel. Remember, there are no right
or wrong answers!

Our classes stay busy and do not waste time.

My teachers expect me to think hard about the things

we read.

My teachers expect everybody to work hard.

My school is an artsy, creative place.

My classmates behave the way my teachers want

them to.

Block 7

The following questions are about your school. Please select the answer that best represents how you feel. Remember, there are no right
or wrong answers!

I receive recognition or praise for doing good work.

My teachers know what I am good at.

At my school, some students are treated unfairly

because of who they are.

My classmates treat me with respect.

I don't give up, even when I feel frustrated.

Bullying

Bullying is when a student uses their strength or popularity to injure, threaten, or embarrass another student. Bullying can be physical,
verbal, or social. It is not bullying when two students of about the same strength argue or fight.

At my school, students are bullied:

Bullying is when a student uses their strength or popularity to injure, threaten, or embarrass another student. Bullying can be physical or
verbal. It is not bullying when two students of about the same strength argue or fight.

At my school, students are bullied:

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College

I will go to college after high school:

Yes No Maybe

Gender

Sex is what a person is born. Gender is how a person feels. Please select the response that best describes you:
I am a girl / woman
I am a boy / man
I identify in some other way

Please describe how you identify (optional):

After School

Which of the following activities do you do outside of school?

Select all that apply:
On-campus Off-campus
Dance
Theater
Music
Visual Arts
Sports
Other

Welcome/Unwelcome

Do you ever feel welcome at school? What is one thing your school does to make you feel welcome?

Do you ever feel unwelcome at school? What is one thing your school could do to make you feel more welcome?

End

Thank you for taking the time to complete our survey! Please click the "Next" button to record your responses and to prepare the survey
for the next student.

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