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* 1. What is your first name?

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* 2. What is your last name?

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* 3. What grade are you in?

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* 4. In the class or classes you have a D or F, overall how would you rate your relationship with your teachers.

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* 5. In the class or classes you have a D or F, overall do you feel your teachers encourage you?

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* 6. If you raised your grade during 4th quarter to a C or above, overall do you feel your teachers would happy for you?

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* 7. In the class or classes you have a D or F, have your teachers offered to help you?

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* 8. What would help you feel and do better?

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* 9. When I get an D in a class, my parents feel ________?

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* 10. When I get an F in a class, my parents feel ________?

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* 11. I feel I can get better than D’s and F’s in all subjects.

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* 12. I am currently doing my best.

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* 13. I don't feel like trying any harder.

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