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* 1. I am in grade

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* 2. I attend __________________________ School.  

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* 3. How much do you like your school?

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* 4. How much do the adults at your school care about your feelings?

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* 5. How much do you care about other people's feelings at school?

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* 6. How well do the people at school understand or accept you as a person?

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* 7. How connected do you feel to the adults at your school?

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* 8. How connected do you feel to the students at your school?

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* 9. How confident that you can complete your schoolwork?

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* 10. How often are you successful at solving challenging schoolwork activities?

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* 11. When you get stuck on something difficult, how often to do try another way?

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* 12. How often do you get to make personal choices in your learning?

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* 13. When schoolwork is difficult, how comfortable are you in asking for help?

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* 14. When things go wrong with assignments or you make a mistake, how often do you to try again?

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* 15. How often do you see bullying happen at your school?

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* 16. How often do you worry that your feelings or emotions will be hurt at school?

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* 17. How often to you worry that you will be physically hurt at school?

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* 18. When you are feeling pressured, how easy is it for you to manage your emotions or feelings?

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* 19. When you have a personal concern or problem, how comfortable are you in asking for help?

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