NCYLS Alumni - Track Hours
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1. NCYLS 2009 Student Initial Survey

*
1. Name

Name Name:
High School:
Address:
Address 2:
City/Town:
State:
ZIP:
County:
Email Address:
Phone Number:

2. What is your race/ethnicity?

What is your race/ethnicity? Black/African American

Asian

Latino

Native American

Caucasian

Pacific Islander

Other (please specify)

3. What is your gender?

What is your gender? Male

Female

4. What is your household income?

What is your household income? Under $30,000

$30,000 to $49,000

$50,000 to $69,000

$70,000 or more

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.	*Please choose an item in accordance with your agreement 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

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