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 ACASI, the group working on academic success in Adams County,  wants your opinion.  Please read each question and then mark your opinion.  Thank you.

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* 1. My School district is....

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* 2. Where do you attend school?

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* 3. For questions 4-11, please use the following scale: 1 = Strongly disagree,  to 5= Strongly agree

1 = Strongly Disagree     2 = Somewhat Disagree    3 = Neutral    4 = Somewhat Agree     5 = Strongly Agree

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* 4. I am in charge of how well I do in school.

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* 5. Students in my school help each other even if they are not friends.

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* 6. I can do better at school than I am doing now.

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* 7. At my school, teachers and staff care about the students.

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* 8. I try to do well on my school work even when it isn't interesting.

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* 9. School and education is important for my future.

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* 10. Students in my school get chances to be leaders in different ways.

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* 11. I know what it takes to do well in school.

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* 12. For questions 13 - 19, please use the following scale about how often that feeling or opinion occurs:                            1 = Never  to  5 = Always

1 = Never     2 = Rarely     3 =Sometimes     4 = Often     5 = Always

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* 13. I do my homework before I play or relax.

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* 14. I feel safe at school.

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* 15. Adults at my school listen to students' ideas.

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* 16. I help other students at school without being asked.

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* 17. Overall, adults at my school treat students fairly.

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* 18. Whenever I have a lot of homework and other activities, I create a plan to get things done.

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* 19. Some students at my school are teased or picked on.

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* 20. Please add any additional comments about your school in the box below.

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