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1. Please tell us who you are.

Please tell us who you are. Teacher

Student Teacher

Teacher Assistant

Home School

Parent

Administrator

Counselor

Psychologist

Social Worker

Special Education Teacher

Speech & Language Teacher

Other (please specify)

2. What age groups are of interest to you?

What age groups are of interest to you? Early Childhood (Birth - age 4)

Early Elementary (Kindergarten - Grade 3)

Upper Elementary (Grade 4 - 5)

Middle School/Junior High School

High School

Alternative High School

Other (please specify)

3. What is your greatest challenge when working with at-risk students? Rate each item according to the level of challenge it presents.

	Not at all	Somewhat	Usually	Most of the time
Behavior	What is your greatest challenge when working with at-risk students? Rate each item according to the level of challenge it presents. Behavior Not at all	Behavior Somewhat	Behavior Usually	Behavior Most of the time
Parents	Parents Not at all	Parents Somewhat	Parents Usually	Parents Most of the time
Drug/alcohol use	Drug/alcohol use Not at all	Drug/alcohol use Somewhat	Drug/alcohol use Usually	Drug/alcohol use Most of the time
Attendance	Attendance Not at all	Attendance Somewhat	Attendance Usually	Attendance Most of the time
Academic deficiencies	Academic deficiencies Not at all	Academic deficiencies Somewhat	Academic deficiencies Usually	Academic deficiencies Most of the time
Lack of support from school administration	Lack of support from school administration Not at all	Lack of support from school administration Somewhat	Lack of support from school administration Usually	Lack of support from school administration Most of the time

Other (please specify or comment)

4. As a result of dealing with at-risk students, which of the following outcomes do you experience? Please select all that apply.

	Never	Sometimes	Frequently	Most of the time
Personal sense of accomplishment	As a result of dealing with at-risk students, which of the following outcomes do you experience? Please select all that apply. Personal sense of accomplishment Never	Personal sense of accomplishment Sometimes	Personal sense of accomplishment Frequently	Personal sense of accomplishment Most of the time
Personal feelings of discouragement	Personal feelings of discouragement Never	Personal feelings of discouragement Sometimes	Personal feelings of discouragement Frequently	Personal feelings of discouragement Most of the time
Inability to influence change in students	Inability to influence change in students Never	Inability to influence change in students Sometimes	Inability to influence change in students Frequently	Inability to influence change in students Most of the time
The need for ideas and strategies	The need for ideas and strategies Never	The need for ideas and strategies Sometimes	The need for ideas and strategies Frequently	The need for ideas and strategies Most of the time
Frustration that affects your life outside the classroom	Frustration that affects your life outside the classroom Never	Frustration that affects your life outside the classroom Sometimes	Frustration that affects your life outside the classroom Frequently	Frustration that affects your life outside the classroom Most of the time

Other (please specify or comment)

5. What would be of greatest assistance in helping you with at-risk students?

	Not useful	Somewhat useful	Useful	Extremely useful
Assessment tools for individual students	What would be of greatest assistance in helping you with at-risk students? Assessment tools for individual students Not useful	Assessment tools for individual students Somewhat useful	Assessment tools for individual students Useful	Assessment tools for individual students Extremely useful
Classroom assessment tools	Classroom assessment tools Not useful	Classroom assessment tools Somewhat useful	Classroom assessment tools Useful	Classroom assessment tools Extremely useful
Unit outlines	Unit outlines Not useful	Unit outlines Somewhat useful	Unit outlines Useful	Unit outlines Extremely useful
Lesson plans specially designed to engage challenging students	Lesson plans specially designed to engage challenging students Not useful	Lesson plans specially designed to engage challenging students Somewhat useful	Lesson plans specially designed to engage challenging students Useful	Lesson plans specially designed to engage challenging students Extremely useful
Strategies to achieve the state standards	Strategies to achieve the state standards Not useful	Strategies to achieve the state standards Somewhat useful	Strategies to achieve the state standards Useful	Strategies to achieve the state standards Extremely useful
Strategies to engage parents	Strategies to engage parents Not useful	Strategies to engage parents Somewhat useful	Strategies to engage parents Useful	Strategies to engage parents Extremely useful
Course outlines	Course outlines Not useful	Course outlines Somewhat useful	Course outlines Useful	Course outlines Extremely useful
Process maps/Graphic organizers	Process maps/Graphic organizers Not useful	Process maps/Graphic organizers Somewhat useful	Process maps/Graphic organizers Useful	Process maps/Graphic organizers Extremely useful
Downloadable materials for immediate use in the classroom	Downloadable materials for immediate use in the classroom Not useful	Downloadable materials for immediate use in the classroom Somewhat useful	Downloadable materials for immediate use in the classroom Useful	Downloadable materials for immediate use in the classroom Extremely useful
Parent education	Parent education Not useful	Parent education Somewhat useful	Parent education Useful	Parent education Extremely useful
Tips and encouragement	Tips and encouragement Not useful	Tips and encouragement Somewhat useful	Tips and encouragement Useful	Tips and encouragement Extremely useful

Other (please specify or comment)

6. What content areas are you most interested in?

	No interest	Some interest	Moderate interest	Major interest
Math	What content areas are you most interested in? Math No interest	Math Some interest	Math Moderate interest	Math Major interest
English/Language Arts	English/Language Arts No interest	English/Language Arts Some interest	English/Language Arts Moderate interest	English/Language Arts Major interest
Science	Science No interest	Science Some interest	Science Moderate interest	Science Major interest
Social Studies/History	Social Studies/History No interest	Social Studies/History Some interest	Social Studies/History Moderate interest	Social Studies/History Major interest
Computer Skills	Computer Skills No interest	Computer Skills Some interest	Computer Skills Moderate interest	Computer Skills Major interest
Fine Arts	Fine Arts No interest	Fine Arts Some interest	Fine Arts Moderate interest	Fine Arts Major interest

Other (please specify or comment)

7. What academic skill areas would be of most interest to you?

	No interest	Some interest	Moderate interest	Major interest
Reading	What academic skill areas would be of most interest to you? Reading No interest	Reading Some interest	Reading Moderate interest	Reading Major interest
Writing	Writing No interest	Writing Some interest	Writing Moderate interest	Writing Major interest
Spelling	Spelling No interest	Spelling Some interest	Spelling Moderate interest	Spelling Major interest
Computation	Computation No interest	Computation Some interest	Computation Moderate interest	Computation Major interest
Math concepts	Math concepts No interest	Math concepts Some interest	Math concepts Moderate interest	Math concepts Major interest
Maps and graphs	Maps and graphs No interest	Maps and graphs Some interest	Maps and graphs Moderate interest	Maps and graphs Major interest
Organizational skills	Organizational skills No interest	Organizational skills Some interest	Organizational skills Moderate interest	Organizational skills Major interest
Critical thinking skills	Critical thinking skills No interest	Critical thinking skills Some interest	Critical thinking skills Moderate interest	Critical thinking skills Major interest
Inference skills	Inference skills No interest	Inference skills Some interest	Inference skills Moderate interest	Inference skills Major interest

Other (please specify or comment)

8. Would you be interested in lessons or units that involve the following skills?

	No interest	Some interest	Moderate interest	Major
Anger Management	Would you be interested in lessons or units that involve the following skills? Anger Management No interest	Anger Management Some interest	Anger Management Moderate interest	Anger Management Major
Coping Skills	Coping Skills No interest	Coping Skills Some interest	Coping Skills Moderate interest	Coping Skills Major
Problem Solving	Problem Solving No interest	Problem Solving Some interest	Problem Solving Moderate interest	Problem Solving Major
Anxiety Reduction	Anxiety Reduction No interest	Anxiety Reduction Some interest	Anxiety Reduction Moderate interest	Anxiety Reduction Major
Conflict Resolution	Conflict Resolution No interest	Conflict Resolution Some interest	Conflict Resolution Moderate interest	Conflict Resolution Major
Living Skills	Living Skills No interest	Living Skills Some interest	Living Skills Moderate interest	Living Skills Major
Interpersonal/Social Skills	Interpersonal/Social Skills No interest	Interpersonal/Social Skills Some interest	Interpersonal/Social Skills Moderate interest	Interpersonal/Social Skills Major
Project Planning	Project Planning No interest	Project Planning Some interest	Project Planning Moderate interest	Project Planning Major

Other (please specify or comment)

9. In addition to free offerings from this site, would you prefer to

	Not at all	Somewhat	Probably	Definitely
Pay for each download	In addition to free offerings from this site, would you prefer to Pay for each download Not at all	Pay for each download Somewhat	Pay for each download Probably	Pay for each download Definitely
Pay a membership fee for full access	Pay a membership fee for full access Not at all	Pay a membership fee for full access Somewhat	Pay a membership fee for full access Probably	Pay a membership fee for full access Definitely
Both	Both Not at all	Both Somewhat	Both Probably	Both Definitely

Other (please specify or comment)

10. Would you be interested in receiving information for your personal support and growth?

	Not at all	Somewhat	Probably	Definitely
Fitness	Would you be interested in receiving information for your personal support and growth? Fitness Not at all	Fitness Somewhat	Fitness Probably	Fitness Definitely
Weight Loss	Weight Loss Not at all	Weight Loss Somewhat	Weight Loss Probably	Weight Loss Definitely
Stress Management	Stress Management Not at all	Stress Management Somewhat	Stress Management Probably	Stress Management Definitely
Goal-setting	Goal-setting Not at all	Goal-setting Somewhat	Goal-setting Probably	Goal-setting Definitely
Relaxation Techniques	Relaxation Techniques Not at all	Relaxation Techniques Somewhat	Relaxation Techniques Probably	Relaxation Techniques Definitely

Other (please specify or comment)

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