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* 1. Thinking about school, how much do you agree or disagree with the following?  For each statement, please check the appropriate box.

  Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
1. Students in my school treat one another with respect.
2. Most of my teachers don't understand my life outside of school.
3. I feel emotionally safe in school.
I feel emotionally safe outside of the classroom (restrooms, lockers, hallways, cafeteria, etc)
5. My school disciplines fairly.
6. My principal models respectful behavior.
7. Faculty and staff value what students have to say.
8. My school respects all races and cultures.
9. Students is my school care about learning and getting a good education.
10. Classes in my school are challenging.
11. Students are involved in decisions about things that affect them in school.
12. Most of my teachers are enthusiastic about teaching and communicate this to students.
13. I feel that I belong (am accepted and liked) at school.
14. Most of my teachers like me.
15. I respect most of my teachers.
16. Most of my teachers know me by name.
17. Students in my school help one another even if they are not friends.
18. Teachers at my school are respectful toward one another.
19. I feel physically safe outside of the classrooms (restrooms, lockers, hallways, cafeteria, etc).
20. Students at my school support most extra-curricular activities (not just sports).
21. Students are encouraged to say what they think.
22. I feel physically safe in my classes.

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* 2. How well do each of the following statements describe you?  For each statement, please check the appropriate box.

  Yes No
23. I really want to learn.
24. I participate regularly in class.
25. I often need extra help with schoolwork.
26. It's often hard to pay attention in class because I am worrying about problems outside of school.
27. Have you ever skipped school?
28. Have you ever considered dropping out of school

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* 3. If you answered "yes" to questions 27 & 28, please indicate how often you have skipped  class or school or considered dropping out of school because of any of the below reasons?  If you answered "no" to questions 27 & 28, please skip to question 36.

  Never Once or Twice A Few Times a Year Several Times a Year
29. You did not feel prepared for class.
30. You were being bullied or harassed by other students.
31. You were not getting along with a teacher.
32. You did not feel safe at school.
33. You did not feel safe traveling to and from school.
34. School was boring.
35. You had family responsibilities.

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* 4. How often do your teachers speak to you one-on-one about the following?  For each statement, please check the appropriate box.

  Never Once or Twice A Few Times a Year Several Times a Year
36. Disrupting class.
37. Good academic performance.
38. Not completing assignments.
39. Poor academic performance.
40. Interests and things that are important to you.
41. Your plans for college or work after high school.
42. Your worries

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* 5. At school, think about the connections you have with the adults in the building and answer accordingly.

  Zero One Two or Three Four or More
43. The number of adults you feel you could talk to if you had a problem

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* 6. How much would the following steps help you to learn?  For each statement, please check the appropriate box.

  Help a Lot Help A Little Not at All
44. More one-on-one attention form teachers.
45. More examples of how the things I learn in school matter in the real world.
46. Classes that are more challenging.
47. If other students were more accepting of me.

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* 7. Please rate how well high school is preparing you for the following, please check the appropriate box.

  Strongly Agree Somewhat Agree Somewhat Disagree  Strongly Disagree
48. Time Management
49. Goal Setting
50. Resume Writing
51. Job Interviews
52. Personal Finance - check writing, banking etc.
53. Career Planning
54. Work Habits

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* 8. Please indicate your gender.

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* 9. Do your parents usually speak a language other than English at home?

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* 10. Please indicate your grade level.

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* 11. Think of the best teachers you have had.  What are the qualities that made them good teachers?

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* 12. What do you think are the most important issues that need to be addressed in your school?

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* 13. Please answer yes or no to the following questions

  Yes No
Do you like the current lunch/enrichment format?
Would you like more free time at lunch?
Do you think students could self manage themselves if they had free time at lunch?
Would you like to be able to eat lunch other places in the building other than the cafeteria?
Would you like clubs/activities to meet during the day, for example during lunch/enrichment?
Would you be more inclined to joins clubs and activities if they were held during the day?

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* 14. Where would you like to be able to eat lunch at throughout the building, other than the cafeteria?

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* 15. On a typical day, do you buy lunch or pack lunch from home?

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