1. Student's First Name

2. Student's Last Name

3. Student's Grade

4. 10- Digit Student ID

5. School Name

6. Gender

7. Do you have Native Hawaiian ancestry?

8. What are your best strengths at school? Click all that apply.

9. What areas do you need the most help with in school? Please click all that apply.

10. Choose the response that fits best.

  Never Sometimes Often Very often Always
I like going to school.
I enjoy math.
I enjoy science.
I enjoy reading.
I enjoy writing.
I study hard for tests.
I enjoy using technology.
I work well during group work.
I enjoy engineering.
I like working with a team on projects.
I like solving complex problems.

11. Choose the response that fits best.

  Never Sometimes Often Very often
Do you feel safe after school?
Do you get into trouble at school?
Do you feel there is an adult at school to help when you need it?
Can adults at home help you with your homework?
Do you think it would be helpful to have tutors or mentors help with homework?
Do you complete your school/homework on time?
Do you feel comfortable talking to teachers and school staff?

12. Choose the answer that fits best.

  Bad Fair Good Excellent
How do you feel about yourself?
How do you feel about your ability to make new friends?
How do you feel about your ability to learn something new?
Do you feel confident in your abilities at school?
What word describes how well you get along with other classmates?
What word describes how well you get along with your teachers?

13. What STEM career interests you?
What do you like about this career?
(You may write about more than one).

14. Did your Parent or Guardian attend college?

15. At home, with relatives or friends, I talk about....

  Never Sometimes Often Very often
Completing Homework/Schoolwork
Earning good grades
Graduating high school
Having an internship
Graduating college
Earning a higher education degree
Working in a STEM related career

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