* 1. Your School (type out school name)

* 2. Class/Team Name (if you do not have a team name or advisory teacher, please enter 0)

* 3. City

* 4. State

To what extent do you agree or disagree with the following statements?

* 5. Since the Respect Retreat, I feel more a part of my school.

* 6. Since the Respect Retreat, I have more respect for myself.

* 7. Since the Respect Retreat, I show more respect for others who may not share my view.

* 8. I am respectful to all the students in this school, not just my friends.

* 9. Since the Respect Retreat, I stand up to negative peer pressure.

* 10. Since the Respect Retreat, I enjoy school more.

* 11. Since the Respect Retreat, bullying is less of a problem at my school.

* 12. I treat teachers with respect even if I disagree with them. 

* 13. Adults at my school care about all students, not just a few.

* 14. I would recommend the Respect Retreat for other students. 

Read the statement below and choose the correct answer.

* 15. Respect Means:

Read the statements below and choose the correct answer.

* 16. The Respect Retreat helped me set a personal goal to:

* 17. I have followed through on my commitment to respect:

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