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Background Questions (Mandatory to answer)

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* During the day, are you taking care of anyone in your family such as siblings, parent and/or grandparents?

Learning Models

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* How difficult or easy is it to use the distance learning technology (computer, tablet, video calls, learning applications, etc.)?

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* How difficult or easy is it to manage school work, time away from school, and homework?

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* How satisfied are you with the amount of time you spend speaking with your teachers?

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* How satisfied are you with the amount of time you spend speaking with your friends from school?

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* How would you like to be learning right now? Please rate the following statements.

  Strongly Agree Agree Disagree Strongly Disagree Don't Know
I like the balance between asynchronous and synchronous learning.
I believe that there is a good balance between classroom learning and homework assignments.
I like learning remotely.
I wish I spent more time learning at school and less time learning at home.

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* What would you like to see continued with how you are learning right now?

Please rank the following:

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* What would like to see changed about how you are learning right now?

Please rank the following:

Public Health

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* If we were to return to campus it would be a requirement to wear a mask, would you feel comfortable wearing a mask for 3-4 hours a day while on campus?

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* If we were to return to campus can you ensure you follow safety procedures such as: wearing a mask, physical distancing, taking a health self assessment prior to coming onto campus, and having your temperature taken?

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* (Optional) What safety procedures do you want to see or what are your general concerns with safety if we return to campus?

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* (Optional) Do you have family members who are at risk for Covid due to immune compromised health or other factors?

Academic Needs

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* Are you getting all the help you need with your schoolwork right now?

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* Are you getting enough time/ resources to perform in your classes to the best of your ability?

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* Do you have enough time to spend on your hobbies/ extracurricular activities?

Student Relationships and Self

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* Are there adults at your school you can go to for help if you need it right now?

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* How connected do you feel to other students at your school right now?

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* (Optional ) During the pandemic, what are the ways that you have seen yourself grow or learn new things?

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* (Optional) During the pandemic, what are things that you feel like you’ve lost?

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* (Optional) Many adults in education right now are very focused on the idea of “learning loss.” They think that kids are falling behind academically during the pandemic. What do you want those adults to know about you and your experience during the pandemic?

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* Would you like to talk privately with a teacher, counselor, or other adult from your school about how you are doing or for extra support?

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