* 1. Please tell us how much you agree or disagree:

  Strongly Disagree Disagree Agree Strongly Agree
What I am taught at school is important.
Doing well in school is important for when I grow up.
What I am learning in math is important.
What I am learning in ELA is important.
What I am learning at school is useful in my everyday life.

* 2. Please answer the following questions about homework and studying

  Seldom or never Sometimes Usually Always
I like doing homework and studying.
Studying and doing homework helps me learn.
When I have homework, I hand it in on time.

* 3. Please tell us how much you agree or disagree:

  Strongly Disagree Disagree Agree Strongly Agree
I like learning new things at school.
I try hard to do well in ELA.
I look forward to ELA class.
I enjoy learning new concepts and ideas.
I try hard to succeed in ELA.
I ask for help when I do not understand a concept or idea.
I participate in class discussions.
I get bored in class because lessons are too easy.
ELA class is challenging
Our teacher is good at explaining difficult ideas.
Our teacher uses class time to help us learn.

* 4. Please tell us how much you agree or disagree:

  Strongly Disagree Disagree Agree Strongly Agree
I try hard to do well in Math.
I enjoy learning new concepts and ideas.
I want to learn more about math.
I find myself thinking about what we are learning even after the class is over.
The things we learn at school are meaningful.
The things we learn at school are useful in my everyday life.
I know the purpose of what we are learning at school.
I get bored in class because lessons are too easy.
I ask for help when I need it.
Our teacher is good at explaining difficult ideas.
Our teacher uses class time to help us learn.

* 5. Please tell us how much you agree or disagree:

  Strongly Disagree Disagree Agree Strongly Agree
I make friends easily at school.
School is a place where I feel like I belong.
When I do something, I do it well.
I feel accepted by other kids my age.
A lot of things are good about me.

* 6. Do you have close friends that you can trust?

* 7. I talk to a friend at school about my feelings.

* 8. I get along with others at school.

* 9. I listen to my friends when making decisions.

* 10. During the past 4 weeks how often have you been in trouble at school for any of the following:

  Never or hardly ever Once or twice 3 or 4 times At least 5 times
Being noisy in class
Saying things you should not say
Getting into fights
Breaking a school rule
Not listening to your teacher

* 11. We would like to know how you feel about certain things. For each statement below, please tell us how often you feel this way:

  Never or hardly ever Once or twice a week 3 or 4 times a week Almost every day
I worry about what other students think of me. 
I am too fearful or nervous.
A lot of things seem to bother me.
I worry about people laughing at me.
I worry about a teacher asking me a question.
I worry more than most kids.
 I am afraid that other students will think I am stupid.

* 12. Bullying is when a person tries to hurt another person, and does it more than once. It can be physical, verbal, social, and can also take place over the internet with emails or text messages. Sometimes a group of students will bully others. In the past 4 weeks, has the same person:

  yes no
Pushed or punched you more than once?
Called you names or teased you more than once?
Told lies about you or tried to make you look bad more than once?

* 13. Think of the last time you were bullied. What did you do? (Check any that are true for you.)

* 14. Last time you saw a student being bullied, what did you do?

  Yes No
I told my parents about it.
I told an adult at school about it.
I told a friend about it.
I tried to make the person who was being bullied feel better
I told the person being bullied to ignore it.
I stood up for the person being bullied.
I helped the person being bullied to fight back.
I tried to talk to the bully about it.
I was nice to the person who was bullied.
I did not do anything about it.
I did something else.

* 15. At our school, when do you think bullying most often occurs? From the list please check the time you think it most happens.

* 16. From the list please check the place where you think bullying happens most often.

* 17. In our school...

  Strongly Disagree Disagree Agree Strongly Agree
Teachers know when bullying is happening.
Teachers stop bullying when they see it.
There are safe ways for students to report bullying.
Students know what will happen if they are caught bullying.
Students can talk to adults in the school when they have been bullied.
Teachers help students understand bullying.
Teachers teach students what to do when they are bullied.

* 18. In our school...

  Strongly Disagree Disagree Agree Strongly Disagree
Our teachers treat us fairly.
Our teachers expect us to pay attention.
Students must work hard to succeed.
Our teachers praise us when we have done well.
Students are quiet when they need to be.
Our teachers encourage students to do better.

* 19. In our school...

  Strongly Disagree Disagree Agree Strongly Agree
I get along with my teachers.
Students behave in class.
Our teachers expect homework to be done on time.
Our teachers have control of the class.
Students are clear about what is expected of them.

* 20. In our school...

  Strongly Disagree Disagree Agree Strongly Agree
Our teachers care about me.
Teachers do not let us fool around in class
Our teachers expect us to work hard.
Teachers help students who need extra help.
I know what the class rules are.
Our teachers expect all students to do their best work.

* 21. How often do your parents or other family members do each of the following?

  Never Once a week 2 to 3 times a week Almost every day
Ask me how well I am doing with my school work.
Talk to me about any problems I might have at school.
Talk to me about why it is important that I do well at school.
Ask me how well I am getting long with kids at school.
Show interest in my school projects.
Encourage me to do well at school.

* 22. Please tell us some of the things you really like about your school, or things that would make it even better.

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