* 1. During the past 4 weeks how often have you been spoken to by a teacher for any of the following:

  Never or hardly ever Once or twice 3 or 4 times At least 5 times
Being disruptive in class.
Making inappropriate comments.
Getting into fights.
Breaking a school rule.
Lying or cheating.

* 2. Please indicate how much you agree with each of the following statements:

  Strongly Disagree Disagree Agree Strongly Agree
It is important for me to learn what is taught at school.
I am learning the skills I will need for success later in life.
The Math I am learning will be very useful for the future.
The skills I am learning in ELA will be useful in the future.
What I learn at school is useful in my everyday life.

* 3. Please answer the following questions about homework you are assigned in your class:

  Seldom or never Sometimes Usually Always
I enjoy my homework and studying.
Studying and doing my homework helps me learn.
When I have homework, I hand it in on time.

* 4. We want you to think about the ELA classes you have had over the past 2 weeks. Please indicate the extent to which you agree or disagree with each of the following statements:

  Strongly Disagree Disagree Agree Strongly Agree
I spend a lot of time day-dreaming, socializing, or pretending to pay attention.
I enjoy our class projects so much that often I do not want to stop.
I enjoy ELA classes so much that I lose track of time.
I enjoy learning new concepts and ideas.
I wish we did not have to take ELA,
I find myself thinking about what we are learning even after the class is over.
I try hard to succeed in ELA.
I ask for help when I do not understand a concept or idea.
I participate in class discussions.
I get bored in class because lessons are too easy.
ELA classes are challenging.
Our teacher is good at explaining difficult ideas.
Our teacher uses class time to help us learn.
We explore ideas and topics that are meaningful.
We cover topics that are useful in everyday life.
I know the purpose of what we are learning.
I know what I need to work harder on for this class.
We have opportunities to revise and practice the things that are important.
When I do not understand something our teacher explains it another way.

* 5. We want you to think about the Math classes you have had over the past 2 weeks. Please indicate the extent to which you agree or disagree with each of the following statements:

  Strongly Disagree Disagree Agree Strongly Agree
I spend a lot of time day-dreaming, socializing, or pretending to pay attention.
I enjoy our class projects so much that often I do not want to stop.
I enjoy math classes so much that I lose track of time.
I enjoy learning new concepts and ideas.
I wish we did not have to take math.
I find myself thinking about what we are learning even after the class is over.
I try hard to succeed in Math.
I ask for help when I do not understand a concept or idea.
I participate in class discussions.
I get bored in class because lessons are too easy.
Math classes are challenging.
Our teacher is good at explaining difficult ideas.
Our teacher uses class time to help us learn.
We explore ideas and topics that are meaningful.
We cover topics that are useful in everyday life.
I know the purpose of what we are learning.
I know what I need to work harder on for this class.
We have opportunities to revise and practice the things that are important.
When I do not understand something our teacher explains it another way.

* 6. Please indicate how much you agree or disagree with the following statements:

  Strongly disagree Disagree  Agree Strongly Agree
In general, like the way I am.
I like the way I look.
When I do something, I do it well.
Overall, I have a lot to be proud of.
A lot of things are good about me.
I feel good about my ability to do school work.
I feel good about myself.

* 7. We would like to know how you think and feel about certain things. For each statement below, please tell us how often you feel this way.

  Never or hardly ever Once or twice a week 3 or 4 times a week Almost every day
I am concerned about what other students think about me.
I feel sad or depressed.
I am too fearful or nervous.
A lot of things seem to bother me.
I worry about people laughing at me.
I feel lonely.
I worry about a teacher asking me a question.
I cry without a good reason.
I worry more than most kids.
Other students seem to be having more fun than me.
I am afraid that other students will think I am stupid.
I have trouble falling asleep at night.

* 8. Please indicate how much you agree with each of the following statements:

  Strongly Disagree Disagree  Agree Strongly Agree
I feel included in school.
i get along well with others at school.
I am able to make friends easily.
At school I feel accepted for who I am.
School is a place where I feel like I belong.
I feel accepted by other kids in my class.

* 9. Do you have close fiends that you can trust?

* 10. I share my private feelings with a friend at school.

* 11. During the past 4 weeks, how well have you gotten along with your friends at school?

* 12. I value my friends' opinions when making decisions.

* 13. We want to find about student bullying. Bullying is when a person tries to hurt another person, and does it more than once. It can be physical, verbal, social, and can also take place over the internet with emails or text messages. Sometimes a group of students will bully others. In the past 4 weeks how often have you been:

  Never or hardly ever About once a week About 2 or 3 times a week Almost every day
Physically bullied? (example: pushed, punched, or scared by someone?)
Verbally bullied? (example: called names, teased, or threatened)
Socially bullied? (example: excluded by others, had rumors spread about you, or had someone try and make you look bad)
Cyber bullying? (example: called names, teased, or threatened by email, text messages, or social media)

* 14. Think of the last time you were bullied. What did you do? (Check any that are true for you.)

* 15. How often do your parents or other family members do each of the following?

  Never Once a week 2 or 3 times a week Almost every day
Ask me how well I am doing with my school work.
Talk to me about any problems I might have at school.
Talk to me about why it is important that I do well at school.
Ask me how well I am getting along with kids at school.
Show interest in my school projects.
Encourage me to do well at school.

* 16. Think of the last time you saw or heard about a student being bullied. What did you do?( Check any that are true for you.)

  Yes No
I told my parents about it.
I told an adult at school about it.
I tried to comfort the person who was being bullied.
I encouraged the person being bullied to ignore it.
 I stood up for the person who was being bullied.
I helped the person being bullied to fight back.
I tried to talk to the bully about it.
I made and effort later to include the person who was being bullied.
I ignored it.
I did something else.

* 17. At our school when do you think bullying most often occurs? From the list, please check the time when you think it most happens.

* 18. From the list please check the place where you think bullying happens most often.

* 19. In our school...

  Strongly Disagree Disagree Agree Strongly agree
School staff recognize bullying when it happens.
School staff step in immediately when they observe a student being bullied.
There are safe ways for students to report bullying.
There clear consequences for bullying that are consistently enforced.
School staff provide adequate supervision in class and between classes to prevent bullying.
There are adults in the school that students can talk to when they are victims of bullying.
School staff help students understand bullying.
School staff teach students what to do when they are bullied.

* 20. In our school...

  Strongly Disagree Disagree Agree Strongly agree
Our teachers get along well with students.
It is usually easy to concentrate in class.
Our teachers expect homework to be done on time.
Our teachers show an interest in every student's learning.
Our teachers maintain control of the class.
Students are clear about what is expected of them.

* 21. In our school...

  Strongly Disagree Disagree Agree Strongly agree
Our teachers take account of students' needs, abilities, and interests.
Our teachers do not let students get away with much fooling around.
Our teachers expect us to work hard.
 Our teachers work hard to help students who need extra support.
The rules for classroom behavior are clear.
Our teachers expect all students to do their best work.

* 22. Please indicate how much you agree with each of the following statements:

  Strongly Disagree Disagree Agree Strongly Agree
I plan to finish high school.
After high school, I am interested in pursuing a trade or apprenticeship program(example:carpenter, mechanic, plumber, etc.)
After high school, I am interested in attending college or university.

* 23. Please tell us some of the things you really like about your school, or things that would make it even better.

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