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* 1. First and Last Name

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* 2. Gender

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* 3. Team and Grade

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* 4. Do you worry about any of these items?

  Never Sometimes Often
Being teased or made fun of at school by peers
Being liked by my teachers
Getting all my HW done
Getting good grades
Taking tests
Doing well on a sports team
My health
How I look
My weight
Having friends
Finding a seat or table in the cafeteria
Having my personal items taken at school
Making poor choices to fit in
Drugs or alcohol in the middle school
Your friends using drugs or alcohol

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* 5. Do you participate in any after-school sports here at the middle school?

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* 6. Do you participate in any after-school clubs here at the middle school?

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* 7. Do you participate in any community-based activities (sports, church, lessons, scouts, etc.)?

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* 8. How many days a week do you stay after school for extra help from teachers?

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* 9. Do you feel that you have friends at middle school?

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* 10. How many adults at school do you feel know you on a personal level?

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* 11. Do you feel any adults in school know you on a personal level (would notice if you are happy, excited, upset, sad, etc.) Select all that apply.

T