Thank you for answering these questions. What you say will help us to understand what school is like for you. We won't share what you say with your teacher or principal, please answer the questions honestly!

* 1. What school do you go to?

* 2. What is your first name?

* 3. What is your last name?

* 4. What is your student ID number? (Leave blank if you don't know it)

* 5. What grade are you in?

* 6. What is your teacher's name?

* 7. What language do you speak at home? (Please choose all that apply)

* 8. Please say how true each of these statements is about you:

  Not at all true A little true Mostly true Completely true
I can do even the hardest homework if I try
I can learn the things taught in school
I can figure out difficult homework

* 9. Please say how often each of these statements is true for you:

  Never Hardly ever Some of the time Most of the time All of the time
1. I pay attention in class
2. When I am in class, I just pretend to be working
3. I follow the rules at school
4. I get in trouble at school
5. I feel happy in school
6. I feel bored in school
7. I feel excited by the work in school
8. I like being at school
9. I am interested in the work at school
10. My classroom is a fun place to be
11. When I read a book, I ask myself questions to make sure I understand what it is about
12. I study at home even when I don’t have a test
13. I try to watch TV shows about things we are doing in school
14. I check my schoolwork for mistakes
15. I read extra books to learn more about things we do in school
16. Outside of school, I try to learn more about things we do in school

* 10. Which of these is most like you? (Pick ONE)

* 11. Please click in the circle that matches how often you do each of these things when you are doing schoolwork:

  NeverNever Sometimes UsuallyUsually  Always
I read instructions carefully before I begin my work
I make a list of the main things I’ve learned after I finish
I ask myself if I learned as much as I could have once I finish my work
I set goals before I begin my work
While I am doing my work, I ask myself if I am meeting my goals
I organize my time to best accomplish my goals
I ask myself how well I accomplished my goals once I’m finished
I ask myself questions about how well I am understanding while I am learning something new
I think of several ways to solve a problem before I begin, and then choose the best one
I find myself thinking about whether the plan I made to do my work is useful
While I am doing schoolwork, I check myself to make sure I am understanding
I know how well I did once I finish a test

* 12. Please say whether you disagree or agree with these statements. If you are not sure, mark "not sure"

  DisagreeDisagree Not SureNot Sure AfreeAgree
I know who to ask for help with schoolwork when I need it
I am comfortable asking for help with schoolwork when I need it
I feel I can ask my friends for help with schoolwork
I feel I can ask my teacher for help with schoolwork
I feel I can ask someone in my family for help with schoolwork

* 13. Please answer each question below:

  Never Some Usually Always
How often do you get to choose what you want to study?
How often do you get to choose how you show what you have learned?
How often do you get to choose where you sit in the classroom?
How often does your teacher give you the chance to explain how you learn best?
Do you like to share your ideas in class, even if nobody else agrees with you?
How often does your teacher listen to your suggestions?

* 14. Please say whether you think each statement is Not True (red thumbs down) or True (green thumbs up)

  Not true True
Asking your teacher for help in class makes you look needy or nerdy.
Asking your teacher for help shows that you are thinking about what you are learning.
Asking your teacher for help means that you trust the teacher to help you.
Asking your teacher for help means you are the teacher’s favorite or a teacher’s “pet”.

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