NCYLS Alumni - Track Hours

1. NCYLS 2009 Student Initial Survey

Question Title

* 1. Name

Name: *

High School:

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

County:

Email Address: *

Phone Number: *

Question Title

* 2. What is your race/ethnicity?

Black/African American

Asian

Latino

Native American

Caucasian

Pacific Islander

Other (please specify)

Question Title

* 3. What is your gender?

Male

Female

Question Title

* 4. What is your household income?

Under $30,000

$30,000 to $49,000

$50,000 to $69,000

$70,000 or more

Question Title

* 5. Please choose an item in accordance with your agreement

	1 Strongly Disagree	2	3	4	5	6 Strongly Agree	N/A
1. I consider myself a leader.	1. I consider myself a leader. 1 Strongly Disagree	1. I consider myself a leader. 2	1. I consider myself a leader. 3	1. I consider myself a leader. 4	1. I consider myself a leader. 5	1. I consider myself a leader. 6 Strongly Agree	1. I consider myself a leader. N/A
2. I am passionate about my personal beliefs.	2. I am passionate about my personal beliefs. 1 Strongly Disagree	2. I am passionate about my personal beliefs. 2	2. I am passionate about my personal beliefs. 3	2. I am passionate about my personal beliefs. 4	2. I am passionate about my personal beliefs. 5	2. I am passionate about my personal beliefs. 6 Strongly Agree	2. I am passionate about my personal beliefs. N/A
3. I believe I can make a positive impact on my community or others around me.	3. I believe I can make a positive impact on my community or others around me. 1 Strongly Disagree	3. I believe I can make a positive impact on my community or others around me. 2	3. I believe I can make a positive impact on my community or others around me. 3	3. I believe I can make a positive impact on my community or others around me. 4	3. I believe I can make a positive impact on my community or others around me. 5	3. I believe I can make a positive impact on my community or others around me. 6 Strongly Agree	3. I believe I can make a positive impact on my community or others around me. N/A
4. I consider myself a positive person.	4. I consider myself a positive person. 1 Strongly Disagree	4. I consider myself a positive person. 2	4. I consider myself a positive person. 3	4. I consider myself a positive person. 4	4. I consider myself a positive person. 5	4. I consider myself a positive person. 6 Strongly Agree	4. I consider myself a positive person. N/A
5. I feel comfortable speaking in large groups.	5. I feel comfortable speaking in large groups. 1 Strongly Disagree	5. I feel comfortable speaking in large groups. 2	5. I feel comfortable speaking in large groups. 3	5. I feel comfortable speaking in large groups. 4	5. I feel comfortable speaking in large groups. 5	5. I feel comfortable speaking in large groups. 6 Strongly Agree	5. I feel comfortable speaking in large groups. N/A
6. When no one has been assigned as the leader of a group, I feel very comfortable taking on a leadership role.	6. When no one has been assigned as the leader of a group, I feel very comfortable taking on a leadership role. 1 Strongly Disagree	6. When no one has been assigned as the leader of a group, I feel very comfortable taking on a leadership role. 2	6. When no one has been assigned as the leader of a group, I feel very comfortable taking on a leadership role. 3	6. When no one has been assigned as the leader of a group, I feel very comfortable taking on a leadership role. 4	6. When no one has been assigned as the leader of a group, I feel very comfortable taking on a leadership role. 5	6. When no one has been assigned as the leader of a group, I feel very comfortable taking on a leadership role. 6 Strongly Agree	6. When no one has been assigned as the leader of a group, I feel very comfortable taking on a leadership role. N/A
7. I think volunteerism is important in my community	7. I think volunteerism is important in my community 1 Strongly Disagree	7. I think volunteerism is important in my community 2	7. I think volunteerism is important in my community 3	7. I think volunteerism is important in my community 4	7. I think volunteerism is important in my community 5	7. I think volunteerism is important in my community 6 Strongly Agree	7. I think volunteerism is important in my community N/A
8. I am personally interested in doing volunteer work.	8. I am personally interested in doing volunteer work. 1 Strongly Disagree	8. I am personally interested in doing volunteer work. 2	8. I am personally interested in doing volunteer work. 3	8. I am personally interested in doing volunteer work. 4	8. I am personally interested in doing volunteer work. 5	8. I am personally interested in doing volunteer work. 6 Strongly Agree	8. I am personally interested in doing volunteer work. N/A
9. I believe this seminar will help me improve my leadership skills.	9. I believe this seminar will help me improve my leadership skills. 1 Strongly Disagree	9. I believe this seminar will help me improve my leadership skills. 2	9. I believe this seminar will help me improve my leadership skills. 3	9. I believe this seminar will help me improve my leadership skills. 4	9. I believe this seminar will help me improve my leadership skills. 5	9. I believe this seminar will help me improve my leadership skills. 6 Strongly Agree	9. I believe this seminar will help me improve my leadership skills. N/A
10. I volunteer on a regular basis.	10. I volunteer on a regular basis. 1 Strongly Disagree	10. I volunteer on a regular basis. 2	10. I volunteer on a regular basis. 3	10. I volunteer on a regular basis. 4	10. I volunteer on a regular basis. 5	10. I volunteer on a regular basis. 6 Strongly Agree	10. I volunteer on a regular basis. N/A
11. My school has a community service requirement to graduate.	11. My school has a community service requirement to graduate. 1 Strongly Disagree	11. My school has a community service requirement to graduate. 2	11. My school has a community service requirement to graduate. 3	11. My school has a community service requirement to graduate. 4	11. My school has a community service requirement to graduate. 5	11. My school has a community service requirement to graduate. 6 Strongly Agree	11. My school has a community service requirement to graduate. N/A
12. I am involved in student government/leadership classes.	12. I am involved in student government/leadership classes. 1 Strongly Disagree	12. I am involved in student government/leadership classes. 2	12. I am involved in student government/leadership classes. 3	12. I am involved in student government/leadership classes. 4	12. I am involved in student government/leadership classes. 5	12. I am involved in student government/leadership classes. 6 Strongly Agree	12. I am involved in student government/leadership classes. N/A