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G.E.M. Girls Gather Chapter Info
This survey will help G.E.M. understand the dynamic of your school/entity
1.
Please write first and last name of person filling out this form
2.
Please write your email address
3.
Please write the name of the school/entity that will host the G.E.M. Program
4.
Please write the best phone number to contact you
5.
Please share the number of girls who will be in your G.E.Ms Gather Group Chapter
6.
Please select the grade level for the girls in your G.E.M.s Gather Group
6th Grade
7th Grade
8th Grade
9th Grade
6th/7th Grade
7th/8th Grade
6th-8th Grade
7.
Please select all that apply: Share the ethnic demographic of the girls you will be serving
Black (African American)
Hispanic
Asian
Pacific Islander
White (Caucasian)
American Indian
Other
8.
Please select the average grade point average for the girls participating in the G.E.M.'s Gather Group
4.0 or higher
3.99-3.0
2.99-2.0
1.99-1.0
.99 and lower
9.
Are any of the G.E.M participants At-Hope Youth
Yes
No
10.
What is the average of the school attendance rate for the G.E.M. participants
100% attendance
90% attendance
80% attendance
70% attendance
60% attendance
50% or lower attendance
11.
Please select the types of discipline or behavior concerns the G.E.M. participants exhibit
Disruptive
Anger outbursts
Tardiness to class
Defiance
Crying often
Non-responsive
Lack of completing school work
Other (please specify)
12.
Please select the social and emotional concerns the G.E.M. participants are often seen for
Anxiety
Stress
Conflict or Girl Drama
Withdrawn
Low self-esteem
Bullying/Teasing
Lack of emotion regulation
Worry
Other (please specify)
Current Progress,
0 of 12 answered