Dear Student,
We need your help! Your feedback is very important. This survey is confidential - your individual answers will not be shared with anyone. All data will be aggregated and de-identified before it is shared with others.

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. What is your student ID number?

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* 4. What grade are you in?

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* 5. What is your teacher's name?

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* 6. What is your gender?

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* 7. Is English your first language? 

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* 8. Which school do you attend?

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* 9. Please indicate your three favorite subjects. (Please check three.)

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* 10. Have you ever...

  Yes  N0
seen a professional dance performance?
participated in a dance?
performed in front of a live audience?
learned something new from watching dance?
learned something new from dance activities?
learned dance vocabulary?

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* 11. Please tell us whether you AGREE or DISAGREE with the following statements.

  Strongly Agree Agree Neither Agree or Disagree Disagree Strongly Disagree
I like to create things.
I like new experiences.
I like to try new things. 
I feel good about myself.
I am not afraid of making mistakes. 
When I set a goal I do not give up.
I am very creative.
I am very interested in the arts (dance, music, theater, visual arts, and/or media arts).
I am very interested in dance.
I care how others are feeling.
I listen to others.
I am interested in learning about people from a different background.
I can learn from people from a different background.
People listen to what I have to say.
Expressing my thoughts is important to me.
I think of myself as an artist. 

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* 12. Please tell us whether you AGREE or DISAGREE with the following statements.

  Strongly Agree Agree Neither Agree or Disagree Disagree Strongly Disagree
I enjoy going to school. 
I have a connection with my teacher(s)
I complete my homework.
I like to participate in class.
I am proud of my work in school. 
I have good study skills. 
I enjoy learning. 
My attendance at school is good. 
I am focused in class. 
I am a confident student. 
My teacher(s) care about me. 

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* 13. Check the words that best describe you. (Please check all that apply.)

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* 14. What do you do during your free time? (Please check all that apply.)

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* 15. Are either of your parents/guardians a professional artist or earn money as an artist? (Actor, Dancer, Designer, Musician, Painter, Photographer, Writer, etc...)

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* 16. Please tell us if your parents/guardians do any of the following activities for fun/in their free time. (Check all that apply.)

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* 17. Please tell us if you have ever been to the following. (Check all that apply.)

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* 18. Please answer the following questions with either a "Yes" or a "No".

  YES NO
Do you think the skills you use to make music and write are similar to each other?
Do you think the skills you use to make music and do math are similar to each other?
Do you think the skills you use to draw/paint and write are similar to each other?
Do you think the skills you use to draw/paint and do math are similar to each other?

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* 19. Please answer the following questions with either a "Yes" or a "No".

  Yes No
Do you use your imagination the same when you draw/paint as when you write?
Do you use your imagination the same when you draw/paint as when you do math?
Do you use your imagination the same when you make music as when you write?
Do you use your imagination the same when you make music as when you do math?
Do you use your imagination the same when you dance as when you write?

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* 20. What has been the most interesting thing that you have done in school?

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