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* 1. My child attends:

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* 2. Are you male or female?

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* 3. What is your Race/Origin? (You may mark one or more races)

How strongly do you agree or disagree with the following statements about this school?

Throughout the survey, "This school" means activities happening in school buildings, on school grounds, on school buses, and at places that hold school-sponsored events or activities. Unless otherwise specified, this refers to normal school hours or to times when school activities/events were in session.

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* 4. I feel that I am involved in school-student activities.

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* 5. This school helps me figure out what social and emotional skills my child needs to develop (e.g. self-control, problem solving, or getting along with others).

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* 6. At this school, my child feels he/she belongs and that staff members care about students and want them to succeed.

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* 7. I feel welcomed at this school.

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* 8. This school encourages me to be an active partner in educating my child and school volunteer.

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* 9. The school provides me with opportunities to participate in making decisions in my child’s education.

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* 10. My child is safe at this school.

This question is about bullying. Bullying happens when one or more students tease, threaten, spread rumors about, hit, shove or hurt another student. It is not bullying when students of about the same strength or power argue or fight or tease each other in a friendly way. Bullies are usually stronger, or have more friends or more money, or some other power over the student being bullied. Usually, bullying happens over and over, or the student being bullied thinks it might happen over and over.

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* 11. Bullying of students at school or school activities is a problem at this school.

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* 12. Bullying of students via electronic means or devices is a problem at this school (cyberbullying).

Drugs means any substance, including those used to get “high” or increase performance in school or sports, other than alcohol or tobacco.  Examples include marijuana, illegal drugs, inhalants, synthetic drugs used to get high (K-2, bath salts, white lightning), or over-the-counter medicine. This does not include medications prescribed by doctor or nurse for the person, but includes prescription drugs that are NOT prescribed to the person by his/her doctor.

“Alcohol” means a full or part of a drink of alcohol. Examples include beer, wine, mixed drink, shot of liquor, or any combination of these alcoholic drinks. This does not include alcohol that you may drink for religious purposes.

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* 13. At this school, I feel that the following are a problem. (May check more than one)

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* 14. The school building is clean and well-maintained.

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* 15. The campus places emphasis on attendance and ensures that students and parents are made aware of attendance goals and incentives.

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* 16. This school has high expectations for students.

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* 17. My child's teachers make themselves available to me and inform me on my child’s progress in school.

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* 18. The principal is willing to listen to my concerns.

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* 19. This school has enough programs that develop students’ social and emotional skills (e.g. self-control, problem solving, or getting along with others).

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* 20. Does the campus hold an annual Title I meeting that explains Title I programs and activities (meeting held at the beginning of the year, ex. Meet the teacher night, open house).

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* 21. This school communicates school policies and procedures clearly to parents or guardians in a language I can understand.

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* 22. Were you provided a copy of the Title I school/parent compact.

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* 23. Discipline is fair.

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