1. School Violence Prevention Survey - EJ

This survey asks for your opinions about how you are doing in school and how safe you feel at school. This survey is anonymous - your name will not be attached to any of the answers. The information will be used to help us improve the program at EJ to better help students be successful.

* 1. Please give the following information

* 2. Grade level

* 3. What is your gender?

* 4. How long have you been enrolled at EJ?

* 5. Are you currently on probation?

* 6. Have you participated in any of the following programs or school activities?

* 7. On a scale of 1 to 5, how would you rate yourself in the following areas?

  Very Poor Poor -2 Ok -3 Good -4 Great-5
Overall attitude towards school
Turning in school work
Attendance
Attitude outside of school
Getting along with others
Getting in trouble at school
Dealing with conflict in your life
Being able to control your anger

* 8. looking ahead to your future, how do you feel about the following statements?

  Strongly Agree Agree Disagree Strongly Disagree
I have definite plans for my future
I feel positive about my future
I am confident I will reach my goals
I have options for my future
There are adults in my life who will support me
There is a purpose to my life
It will be hard, but I will succeed

* 9. What is your plan for the future?

* 10. In the past month, would you say your alcohol/drug use has changed?

* 11. Check the statement that best fits how you feel about your school.

  Strongly agree Agree Disagree Strongly Disagree
I feel close to people at this school
I am happy to be at this school
I feel like I am part of this school
The teachers at this school treat students fairly
I feel safe at this school

* 12. The following questions relate to safety issues on EJ campus

  Yes No
Have you ever belonged to a gang?
Have you brought a weapon to school in the past six months?
Have you seen other students with weapons at school?
Have you ever not come to school because you were afraid?
Are there adults at school you feel you can talk to if you need help?
Do you participate in school activities?
Has anyone harassed you at school this year?
Have you seen other students being harassed at school?

* 13. Please rate how much of a problem you think the following issues are at your school. ( On a scale form 1 to 10 with 10=Very big problem and 1=No problem at all

  Very Big Problem 9 8 7 6 5 4 3 2 No Problem at All I don't know
General School Safety
Violence on Campus(fighting)
Bullying
Sexual Harassment
Violence or threats based on racial differences
Violence or threats based on social group differences
Gangs

* 14. What would make EJ a safer campus?

T