1. Default Section
| | Strongly Disagree | Disagree | Agree | Strongly Agree | N/A |
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| I feel safe at this school. | | | | | |
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| I feel like I belong at this school. | | | | | |
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| I feel challenged at this school. | | | | | |
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| This school is preparing me well for what I want to do after high school. | | | | | |
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| My teachers treat me fairly. | | | | | |
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| My school administrators treat me fairly. | | | | | |
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| Other students at school treat me fairly. | | | | | |
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| I find what I learn in school to be relevant to real life. | | | | | |
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| I feel successful at this school. | | | | | |
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| This school is fun. | | | | | |
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| I like this school. | | | | | |
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| I like to learn. | | | | | |
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| Doing well at school makes me feel good about myself. | | | | | |
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| I am doing my best in school. | | | | | |
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| Participating in extra-curriular activities is important to me. | | | | | |
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| | Strongly Disagree | Disagree | Agree | Strongly Agree | N/A |
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| My ability to write. | | | | | |
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| My ability to read. | | | | | |
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| My math abilities. | | | | | |
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| My public speaking skills. | | | | | |
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| My technology skills. | | | | | |
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| My ability to learn on my own. | | | | | |
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| | Yes | No |
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| I have completed my four-year academic plan. | | |
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| I understand my graduation requirements. | | |
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| I have reviewed my credits and know my progress towards graduation. | | |
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| I am aware of career and college opportunities. | | |
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| I know my educational goals and options. | | |
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| I know my academic strengths and weaknesses. | | |
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| I am keeping a record of my accomplishments and awards. | | |
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| I have visited the college and career center. | | |
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| I know who my counselor is. | | |
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| I have met my counselor. | | |
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| I know how to seek support for personal or social problems. | | |
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| I know the resources available at my school for conflict resolution. | | |
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| I know that counseling services are available to discuss my personal and academic concerns. | | |
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| I have respect for individual differences and can effectively communicate with others. | | |
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| I know at least one adult at school well. | | |
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| If I have a problem with friends, teachers, or my family, I know there is at least one person in this school who can help me solve it. | | |
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