5th Grade Assets Survey
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1. Student Information
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1
. Are you a boy or a girl?
Are you a boy or a girl?
Boy
Girl
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2
. Which one of the following best describes your family?
Which one of the following best describes your family?
I live with two parents.
I live in a one-parent family with my mother.
I live in a one-parent family with my father.
Sometimes I live with my mother and sometimes with my father.
I live with a guardian other than my parents.
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3
. On an average school day, about how much time do you spend doing homework outside of school?
On an average school day, about how much time do you spend doing homework outside of school?
None
30 minutes or less
Between 30 minutes and an hour
1-2 hours
2 hours or more
4
. Where do you go after school each day?
Where do you go after school each day?
home with my family
home by myself
babysitter or day care
SACC program (YMCA)
other family member's house
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