Students as Allies
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1. Thinking about your school, how much do you agree or disagree with the following? For each statement, please check the appropriate box.

2. How well do each of the following statements describe you? For each statement, please check the appropriate box.

	Strongly Disagree	Somewhat Disagree	Somewhat Agree	Strongly Agree
I really want to learn.	How well do each of the following statements describe you? For each statement, please check the appropriate box. I really want to learn. Strongly Disagree	I really want to learn. Somewhat Disagree	I really want to learn. Somewhat Agree	I really want to learn. Strongly Agree
I participate regularly in class.	I participate regularly in class. Strongly Disagree	I participate regularly in class. Somewhat Disagree	I participate regularly in class. Somewhat Agree	I participate regularly in class. Strongly Agree
I often need extra help with schoolwork.	I often need extra help with schoolwork. Strongly Disagree	I often need extra help with schoolwork. Somewhat Disagree	I often need extra help with schoolwork. Somewhat Agree	I often need extra help with schoolwork. Strongly Agree
It's often hard to pay attention in class because I'm worrying about problems outside of school.	It's often hard to pay attention in class because I'm worrying about problems outside of school. Strongly Disagree	It's often hard to pay attention in class because I'm worrying about problems outside of school. Somewhat Disagree	It's often hard to pay attention in class because I'm worrying about problems outside of school. Somewhat Agree	It's often hard to pay attention in class because I'm worrying about problems outside of school. Strongly Agree
I would be open to the idea of meeting with a peer tutor.	I would be open to the idea of meeting with a peer tutor. Strongly Disagree	I would be open to the idea of meeting with a peer tutor. Somewhat Disagree	I would be open to the idea of meeting with a peer tutor. Somewhat Agree	I would be open to the idea of meeting with a peer tutor. Strongly Agree
I would be open to the idea of being a peer tutor for a student who needs assistance.	I would be open to the idea of being a peer tutor for a student who needs assistance. Strongly Disagree	I would be open to the idea of being a peer tutor for a student who needs assistance. Somewhat Disagree	I would be open to the idea of being a peer tutor for a student who needs assistance. Somewhat Agree	I would be open to the idea of being a peer tutor for a student who needs assistance. Strongly Agree

3. How often do your teachers speak with you on-on-one about the following? For each statement please check the appropriate box.

	Never	Once or Twice	A Few Times A Year	Several Times a Year
Disrupting class.	How often do your teachers speak with you on-on-one about the following? For each statement please check the appropriate box. Disrupting class. Never	Disrupting class. Once or Twice	Disrupting class. A Few Times A Year	Disrupting class. Several Times a Year
Good academic performance.	Good academic performance. Never	Good academic performance. Once or Twice	Good academic performance. A Few Times A Year	Good academic performance. Several Times a Year
Not completing assignments.	Not completing assignments. Never	Not completing assignments. Once or Twice	Not completing assignments. A Few Times A Year	Not completing assignments. Several Times a Year
Poor academic performance.	Poor academic performance. Never	Poor academic performance. Once or Twice	Poor academic performance. A Few Times A Year	Poor academic performance. Several Times a Year
Interests and things that are important to you.	Interests and things that are important to you. Never	Interests and things that are important to you. Once or Twice	Interests and things that are important to you. A Few Times A Year	Interests and things that are important to you. Several Times a Year
Your plans for college or work after high school.	Your plans for college or work after high school. Never	Your plans for college or work after high school. Once or Twice	Your plans for college or work after high school. A Few Times A Year	Your plans for college or work after high school. Several Times a Year
Your worries.	Your worries. Never	Your worries. Once or Twice	Your worries. A Few Times A Year	Your worries. Several Times a Year

4. Speaking with adults

	o	1	2-3	More than 3
At school, how many adults do you feel you could talk to if you had a problem?	Speaking with adults At school, how many adults do you feel you could talk to if you had a problem? o	At school, how many adults do you feel you could talk to if you had a problem? 1	At school, how many adults do you feel you could talk to if you had a problem? 2-3	At school, how many adults do you feel you could talk to if you had a problem? More than 3

5. Have you ever skipped class or school?

Have you ever skipped class or school? yes

6. Have you ever considered dropping out of school?

Have you ever considered dropping out of school? yes

7. If you answered yes to question 5 or 6, please indicate how often you have skipped a class/school, or considered dropping out of school because of any of the below reasons. If you answered no to questions 5 and 6 please skip to the next question.

	Never	Once or twice	A few times a year	Several times a year
You felt you did not have any friends.	If you answered yes to question 5 or 6, please indicate how often you have skipped a class/school, or considered dropping out of school because of any of the below reasons. If you answered no to questions 5 and 6 please skip to the next question. You felt you did not have any friends. Never	You felt you did not have any friends. Once or twice	You felt you did not have any friends. A few times a year	You felt you did not have any friends. Several times a year
You were experiencing peer pressure.	You were experiencing peer pressure. Never	You were experiencing peer pressure. Once or twice	You were experiencing peer pressure. A few times a year	You were experiencing peer pressure. Several times a year
You did not feel you belonged.	You did not feel you belonged. Never	You did not feel you belonged. Once or twice	You did not feel you belonged. A few times a year	You did not feel you belonged. Several times a year
You did not feel prepared for class.	You did not feel prepared for class. Never	You did not feel prepared for class. Once or twice	You did not feel prepared for class. A few times a year	You did not feel prepared for class. Several times a year
You were being bullied or harrassed.	You were being bullied or harrassed. Never	You were being bullied or harrassed. Once or twice	You were being bullied or harrassed. A few times a year	You were being bullied or harrassed. Several times a year
You were not getting along with a teacher.	You were not getting along with a teacher. Never	You were not getting along with a teacher. Once or twice	You were not getting along with a teacher. A few times a year	You were not getting along with a teacher. Several times a year
You did not feel safe at school.	You did not feel safe at school. Never	You did not feel safe at school. Once or twice	You did not feel safe at school. A few times a year	You did not feel safe at school. Several times a year
You did not feel safe traveling to and from school.	You did not feel safe traveling to and from school. Never	You did not feel safe traveling to and from school. Once or twice	You did not feel safe traveling to and from school. A few times a year	You did not feel safe traveling to and from school. Several times a year
School was boring- you were not learning anything.	School was boring- you were not learning anything. Never	School was boring- you were not learning anything. Once or twice	School was boring- you were not learning anything. A few times a year	School was boring- you were not learning anything. Several times a year
You had family problems.	You had family problems. Never	You had family problems. Once or twice	You had family problems. A few times a year	You had family problems. Several times a year
You needed to work for money.	You needed to work for money. Never	You needed to work for money. Once or twice	You needed to work for money. A few times a year	You needed to work for money. Several times a year

8. How much would the following steps help you to learn? For each statement, please check the appropriate box.

	Help a Lot	Help a Little	Not at all
More on-on-one attention from teachers.	How much would the following steps help you to learn? For each statement, please check the appropriate box. More on-on-one attention from teachers. Help a Lot	More on-on-one attention from teachers. Help a Little	More on-on-one attention from teachers. Not at all
More examples of how things I learn in school matter in the real world.	More examples of how things I learn in school matter in the real world. Help a Lot	More examples of how things I learn in school matter in the real world. Help a Little	More examples of how things I learn in school matter in the real world. Not at all
Classes that are more challenging.	Classes that are more challenging. Help a Lot	Classes that are more challenging. Help a Little	Classes that are more challenging. Not at all
If other students were more accepting of me.	If other students were more accepting of me. Help a Lot	If other students were more accepting of me. Help a Little	If other students were more accepting of me. Not at all
If I had opportunities to pursue more extra-curricular activities.	If I had opportunities to pursue more extra-curricular activities. Help a Lot	If I had opportunities to pursue more extra-curricular activities. Help a Little	If I had opportunities to pursue more extra-curricular activities. Not at all
More help planning for college or careers.	More help planning for college or careers. Help a Lot	More help planning for college or careers. Help a Little	More help planning for college or careers. Not at all
More parent support.	More parent support. Help a Lot	More parent support. Help a Little	More parent support. Not at all
More fun learning actvities.	More fun learning actvities. Help a Lot	More fun learning actvities. Help a Little	More fun learning actvities. Not at all

9. Please indicate your gender.

Please indicate your gender. Male

Female

10. Please indicate your grade level.

Please indicate your grade level. 9th

10th

11th

12th

	Strongly Disagree	Somewhat Disagree	Somewhat Agree	Strongly Agree
Students in my school treat one another with respect.	Thinking about your school, how much do you agree or disagree with the following? For each statement, please check the appropriate box. Students in my school treat one another with respect. Strongly Disagree	Students in my school treat one another with respect. Somewhat Disagree	Students in my school treat one another with respect. Somewhat Agree	Students in my school treat one another with respect. Strongly Agree
Most of my teachers don't understand what my life is like outside of school.	Most of my teachers don't understand what my life is like outside of school. Strongly Disagree	Most of my teachers don't understand what my life is like outside of school. Somewhat Disagree	Most of my teachers don't understand what my life is like outside of school. Somewhat Agree	Most of my teachers don't understand what my life is like outside of school. Strongly Agree
I feel emotionally safe in my classes.	I feel emotionally safe in my classes. Strongly Disagree	I feel emotionally safe in my classes. Somewhat Disagree	I feel emotionally safe in my classes. Somewhat Agree	I feel emotionally safe in my classes. Strongly Agree
I feel emotionally safe outside of the classroom.	I feel emotionally safe outside of the classroom. Strongly Disagree	I feel emotionally safe outside of the classroom. Somewhat Disagree	I feel emotionally safe outside of the classroom. Somewhat Agree	I feel emotionally safe outside of the classroom. Strongly Agree
My school disciplines students fairly.	My school disciplines students fairly. Strongly Disagree	My school disciplines students fairly. Somewhat Disagree	My school disciplines students fairly. Somewhat Agree	My school disciplines students fairly. Strongly Agree
My principal models respectful behavior.	My principal models respectful behavior. Strongly Disagree	My principal models respectful behavior. Somewhat Disagree	My principal models respectful behavior. Somewhat Agree	My principal models respectful behavior. Strongly Agree
Faculty and staff value what students have to say.	Faculty and staff value what students have to say. Strongly Disagree	Faculty and staff value what students have to say. Somewhat Disagree	Faculty and staff value what students have to say. Somewhat Agree	Faculty and staff value what students have to say. Strongly Agree
My school respects all races and cultures.	My school respects all races and cultures. Strongly Disagree	My school respects all races and cultures. Somewhat Disagree	My school respects all races and cultures. Somewhat Agree	My school respects all races and cultures. Strongly Agree
Students in my school care about learning and getting a good education.	Students in my school care about learning and getting a good education. Strongly Disagree	Students in my school care about learning and getting a good education. Somewhat Disagree	Students in my school care about learning and getting a good education. Somewhat Agree	Students in my school care about learning and getting a good education. Strongly Agree
Classes in my school are challenging.	Classes in my school are challenging. Strongly Disagree	Classes in my school are challenging. Somewhat Disagree	Classes in my school are challenging. Somewhat Agree	Classes in my school are challenging. Strongly Agree
Students are involved in decisions about things that affect them in school.	Students are involved in decisions about things that affect them in school. Strongly Disagree	Students are involved in decisions about things that affect them in school. Somewhat Disagree	Students are involved in decisions about things that affect them in school. Somewhat Agree	Students are involved in decisions about things that affect them in school. Strongly Agree
Most of my teachers are enthusiastic about teaching and communicate this to students.	Most of my teachers are enthusiastic about teaching and communicate this to students. Strongly Disagree	Most of my teachers are enthusiastic about teaching and communicate this to students. Somewhat Disagree	Most of my teachers are enthusiastic about teaching and communicate this to students. Somewhat Agree	Most of my teachers are enthusiastic about teaching and communicate this to students. Strongly Agree
I feel I belong (am accepted) at school.	I feel I belong (am accepted) at school. Strongly Disagree	I feel I belong (am accepted) at school. Somewhat Disagree	I feel I belong (am accepted) at school. Somewhat Agree	I feel I belong (am accepted) at school. Strongly Agree
Most of my teachers like me.	Most of my teachers like me. Strongly Disagree	Most of my teachers like me. Somewhat Disagree	Most of my teachers like me. Somewhat Agree	Most of my teachers like me. Strongly Agree
I respect most of my teachers.	I respect most of my teachers. Strongly Disagree	I respect most of my teachers. Somewhat Disagree	I respect most of my teachers. Somewhat Agree	I respect most of my teachers. Strongly Agree
Students in my school help one another even if they are not friends.	Students in my school help one another even if they are not friends. Strongly Disagree	Students in my school help one another even if they are not friends. Somewhat Disagree	Students in my school help one another even if they are not friends. Somewhat Agree	Students in my school help one another even if they are not friends. Strongly Agree
Teachers at my school are respectful toward one another.	Teachers at my school are respectful toward one another. Strongly Disagree	Teachers at my school are respectful toward one another. Somewhat Disagree	Teachers at my school are respectful toward one another. Somewhat Agree	Teachers at my school are respectful toward one another. Strongly Agree
I feel physically safe outside of the classroom.	I feel physically safe outside of the classroom. Strongly Disagree	I feel physically safe outside of the classroom. Somewhat Disagree	I feel physically safe outside of the classroom. Somewhat Agree	I feel physically safe outside of the classroom. Strongly Agree
Students at my school support most extra-curricular activities (not just sports).	Students at my school support most extra-curricular activities (not just sports). Strongly Disagree	Students at my school support most extra-curricular activities (not just sports). Somewhat Disagree	Students at my school support most extra-curricular activities (not just sports). Somewhat Agree	Students at my school support most extra-curricular activities (not just sports). Strongly Agree
Students are encouraged to say what they think in the classroom.	Students are encouraged to say what they think in the classroom. Strongly Disagree	Students are encouraged to say what they think in the classroom. Somewhat Disagree	Students are encouraged to say what they think in the classroom. Somewhat Agree	Students are encouraged to say what they think in the classroom. Strongly Agree
I feel physically safe in my classes.	I feel physically safe in my classes. Strongly Disagree	I feel physically safe in my classes. Somewhat Disagree	I feel physically safe in my classes. Somewhat Agree	I feel physically safe in my classes. Strongly Agree

Students as AlliesExit this survey

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1. Thinking about your school, how much do you agree or disagree with the following? For each statement, please check the appropriate box.

2. How well do each of the following statements describe you? For each statement, please check the appropriate box.

3. How often do your teachers speak with you on-on-one about the following? For each statement please check the appropriate box.

4. Speaking with adults

5. Have you ever skipped class or school?

6. Have you ever considered dropping out of school?

7. If you answered yes to question 5 or 6, please indicate how often you have skipped a class/school, or considered dropping out of school because of any of the below reasons. If you answered no to questions 5 and 6 please skip to the next question.

8. How much would the following steps help you to learn? For each statement, please check the appropriate box.

9. Please indicate your gender.

10. Please indicate your grade level.

Students as Allies
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