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* 1. How often do you feel that a personal problem keeps you from being your best at school?

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* 2. During the past 30 days, how often did you remain calm, even when someone was bothering you or saying bad things?

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* 3. During the past 30 days, did you not follow directions in class or not do your homework due to one or more of the following? Check all that apply.

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* 4. How many of your teachers are respectful towards you?

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* 5. If you walked into class upset, how many of your teachers would be concerned?

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* 6. How much respect do students in your school show you?

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* 7. How excited are you about going to your classes?

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* 8. How important is it to you, to do well in your classes?

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* 9. Do you feel safe at school?

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* 10. Do you feel you have someone to go to if you are upset?

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