21st Century Community Learning Centers Conflict Resolution
Mid Survey

We would like to have feedback from YOU. This information will help us understand a bit more about you and help us to improve the program.

Question Title

* 1. Test Type

Pre-Test

Mid-Test

Post Test

Question Title

* 2. What school do you attend?

Clay Hill Elementary

Keystone Heights Elementary

Montclair Elementary

Ridgeview Elementary

Question Title

* 3. What is your name?

Question Title

* 4. What is your Student Identification Number?

Question Title

* 5. What is today's date?

Date

Question Title

* 6. Instructions: Please select the answer that best represents how you think and feel.

	Agree a LOT	Agree a Little	Not Sure	Disagree a Little	Disagree a LOT
It is easy for me to talk about my feelings.	It is easy for me to talk about my feelings. Agree a LOT	It is easy for me to talk about my feelings. Agree a Little	It is easy for me to talk about my feelings. Not Sure	It is easy for me to talk about my feelings. Disagree a Little	It is easy for me to talk about my feelings. Disagree a LOT
If I have an argument, I try to work it out with the other student.	If I have an argument, I try to work it out with the other student. Agree a LOT	If I have an argument, I try to work it out with the other student. Agree a Little	If I have an argument, I try to work it out with the other student. Not Sure	If I have an argument, I try to work it out with the other student. Disagree a Little	If I have an argument, I try to work it out with the other student. Disagree a LOT
I yell at other students when I am mad.	I yell at other students when I am mad. Agree a LOT	I yell at other students when I am mad. Agree a Little	I yell at other students when I am mad. Not Sure	I yell at other students when I am mad. Disagree a Little	I yell at other students when I am mad. Disagree a LOT
I know many different words to describe what I feel inside.	I know many different words to describe what I feel inside. Agree a LOT	I know many different words to describe what I feel inside. Agree a Little	I know many different words to describe what I feel inside. Not Sure	I know many different words to describe what I feel inside. Disagree a Little	I know many different words to describe what I feel inside. Disagree a LOT
If a student bothered me, I would walk away.	If a student bothered me, I would walk away. Agree a LOT	If a student bothered me, I would walk away. Agree a Little	If a student bothered me, I would walk away. Not Sure	If a student bothered me, I would walk away. Disagree a Little	If a student bothered me, I would walk away. Disagree a LOT
I can calm myself down when I am upset.	I can calm myself down when I am upset. Agree a LOT	I can calm myself down when I am upset. Agree a Little	I can calm myself down when I am upset. Not Sure	I can calm myself down when I am upset. Disagree a Little	I can calm myself down when I am upset. Disagree a LOT
I push or shove students who make me mad.	I push or shove students who make me mad. Agree a LOT	I push or shove students who make me mad. Agree a Little	I push or shove students who make me mad. Not Sure	I push or shove students who make me mad. Disagree a Little	I push or shove students who make me mad. Disagree a LOT
If I have a conflict, I ask to hear the other student’s side of the story.	If I have a conflict, I ask to hear the other student’s side of the story. Agree a LOT	If I have a conflict, I ask to hear the other student’s side of the story. Agree a Little	If I have a conflict, I ask to hear the other student’s side of the story. Not Sure	If I have a conflict, I ask to hear the other student’s side of the story. Disagree a Little	If I have a conflict, I ask to hear the other student’s side of the story. Disagree a LOT
I ask other students what they feel if I am not sure.	I ask other students what they feel if I am not sure. Agree a LOT	I ask other students what they feel if I am not sure. Agree a Little	I ask other students what they feel if I am not sure. Not Sure	I ask other students what they feel if I am not sure. Disagree a Little	I ask other students what they feel if I am not sure. Disagree a LOT
I call other students names when I am mad.	I call other students names when I am mad. Agree a LOT	I call other students names when I am mad. Agree a Little	I call other students names when I am mad. Not Sure	I call other students names when I am mad. Disagree a Little	I call other students names when I am mad. Disagree a LOT
I try to think of many different ways to solve a problem.	I try to think of many different ways to solve a problem. Agree a LOT	I try to think of many different ways to solve a problem. Agree a Little	I try to think of many different ways to solve a problem. Not Sure	I try to think of many different ways to solve a problem. Disagree a Little	I try to think of many different ways to solve a problem. Disagree a LOT
I stop and think before I act when I am mad or upset.	I stop and think before I act when I am mad or upset. Agree a LOT	I stop and think before I act when I am mad or upset. Agree a Little	I stop and think before I act when I am mad or upset. Not Sure	I stop and think before I act when I am mad or upset. Disagree a Little	I stop and think before I act when I am mad or upset. Disagree a LOT
I will ask a student to play if they don't have someone to play with.	I will ask a student to play if they don't have someone to play with. Agree a LOT	I will ask a student to play if they don't have someone to play with. Agree a Little	I will ask a student to play if they don't have someone to play with. Not Sure	I will ask a student to play if they don't have someone to play with. Disagree a Little	I will ask a student to play if they don't have someone to play with. Disagree a LOT
I listen to other students even when I disagree.	I listen to other students even when I disagree. Agree a LOT	I listen to other students even when I disagree. Agree a Little	I listen to other students even when I disagree. Not Sure	I listen to other students even when I disagree. Disagree a Little	I listen to other students even when I disagree. Disagree a LOT
I tell other students how I feel when they do something I like.	I tell other students how I feel when they do something I like. Agree a LOT	I tell other students how I feel when they do something I like. Agree a Little	I tell other students how I feel when they do something I like. Not Sure	I tell other students how I feel when they do something I like. Disagree a Little	I tell other students how I feel when they do something I like. Disagree a LOT
I tell other students how I feel when they do something I don’t like.	I tell other students how I feel when they do something I don’t like. Agree a LOT	I tell other students how I feel when they do something I don’t like. Agree a Little	I tell other students how I feel when they do something I don’t like. Not Sure	I tell other students how I feel when they do something I don’t like. Disagree a Little	I tell other students how I feel when they do something I don’t like. Disagree a LOT

Question Title

* 7. What is your age today?

Question Title

* 8. What grade are you in?

Kindergarten

1st grade

2nd grade

3rd grade

4th grade

5th grade

6th grade

Other (please describe)

Question Title

* 9. Are you a boy or girl?

Boy

Girl

Question Title

* 10. How do you describe yourself?

White

Black

Hispanic or Latino

American Indian/Native American

Asian

Multiracial