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1.

Hi! Thank you for helping us with this survey. One activity that is very important is for us to get to know you. Below, we are going to ask you some questions and we would like you to answer them as best as you can. Don’t worry about other people knowing what you say. We do not share what you say to us today with anyone (even your teachers and school staff) except the mentoring program staff so that we can make the program as good as we can for you. If you have any questions, please feel free to ask the mentoring program person.

Please only mark one answer per question. There are no right or wrong answers and you are not graded or scored on this survey. We really appreciate your help!

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* 1. Please list your

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* 2. What school do you attend?

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* 3. Peer Aspirations Survey: How important is it to you in the future that:

  Not at All Important Somewhat Important Important Very Important
....you will graduate from high school?
....you will go to college?
....you will have a job that pays well?
....you will stay in good health?
....you will do community work or volunteer work ?
....you will have a good friend that you could count on?

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* 4. Conflict Management Survey: When you think about yourself and how you handle disagreements with your parents and friends, how confident are you that you would:

  Not at All Confident Not Very Confident Unsure Somewhat Confident Very Confident
....stay out of fights?
....understand another person's point of view?
....calm down when you are mad?
....talk out a disagreement?
....learn to stay out of fights?

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* 5. Here is a picture of a ladder. The top of the ladder “10” is the best possible life for you and the bottom “0” is the worst possible life for you. In general, where on the ladder do you feel you stand at the moment? (Circle the number that best describes where you stand.)
10 Best possible life
9
8
7
6
5
4
3
2
1
0 Worst possible life

We say a student is BEING BULLIED when another student, or a group of students, say or do nasty and mean things to him or her. It is also bullying when a student is teased repeatedly in a way that he or she does not like or when other people leave them out of things on purpose. But it is NOT BULLYING when two students of about the same size or strength argue or fight. It is also not bullying when a student is teased in a friendly or playful way.

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* 6. How often have you:

  Never One or Two times 2 or 3 times About once a week Several times a week
Been bullied at school?
Taken part in bullying another student?(s)
These next questions ask about yourself. For each sentence, decide how true the sentence is for you.

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* 7. Are these statements true about you?

  Not True Not Very True Sort of True Very True
I stay on task with my school work.
I'm pretty slow in finishing my school work.
I know when to ask for help with my school work.
I see myself as someone who has high self esteem.
I have lots of friends.
I wish that more people my age liked me.
I am popular with others my age.
I find it hard to make friends.
These questions ask about some things you may have done in the past 30 days. Please remember that ALL of your answers will be kept private. You will not get into trouble if you answer with the truth. Remember that no one else will be told about your answers.

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* 8. In the past 30 days have you:

  Never I have done this but not in the last 30 days 1-2 times in the past 30 days 3 or more times in the past 30 days
Been absent from school. (If it is the summertime, think about he last month you were in school)
Been late for school. (If it is the summertime, think about he last month you were in school)
Skipped school without permission. (If it is the summertime, think about he last month you were in school)
Used tobacco (cigarettes, cigars, chewing tobacco).
Drank alcohol without your parents knowing.
Taken drugs that were not perscribed to you.
These questions are about your plans for high school and college.

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* 9. How sure are you that you will:

  Not at all sure Not really sure Mostly sure Very sure
Finish high school?
Go to college?

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* 10. What is the highest level of education you want to achieve?

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* 11. I feel confident in my ability to ...

  Not True Not Very True Sort of True Very True
Create a specific plan for my future
Research the career I want to have
Set detailed goals
Create a budget
Introduce myself in a professional setting.
Create a thorough resume.
Answer job interview questions.
Dress properly for a job interview.
Achieve my five year goals
Achieve your highest level of education

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* 12. ..

  Yes No
Do you have a five year vision statement for yourself?
Do you have an educational goal to achieve a five year plan
Do you have a 30 sec pitch for yourself when you go on an interview
Did you create and practice an interview pitch with a business mentor

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* 13. Did you achieve your overall academic goal?

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* 14. If no, did you make progress?

 
 50% of survey complete.

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