1.

This information is needed for state reporting. This is not a test. Do not spend too much time on each question. Thank you in advance for your help with this survey.

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* 1. Name

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* 2. Student ID Number

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* 3. Are you a child with a disability?

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* 4. Are you ELL?

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* 6. Gender

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* 7. Grade

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* 9. Do you have a work permit?

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* 10. Have you participated in any of the following ACADEMIC SCHOOL ACTIVITIES during this school year?
(Mark all that apply. If you have not participated in any of these activities, please leave this question blank and do not mark anything.)

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* 11. Have you participated in any of the following ATHLETIC SCHOOL ACTIVITIES during this school year?
(Mark all that apply. If you have not participated in any of these activities, please leave this question blank and do not mark anything.)

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* 12. Have you participated in any of the following MUSICAL SCHOOL ACTIVITIES during this school year?
(Mark all that apply. If you have not participated in any of these activities, please leave this question blank and do not mark anything.)

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