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* I am in _____________ grade.

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* I am a ______________ .

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* Please rate each statement.

  Most of the time Some of the time Not often Almost never
I like school.
I have friends.
I think school is fun.

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* Please rate the following statements about safety. I feel safe . . .

  Most of the time Some of the time Not often Almost never
. . . . in the classroom
. . . . on the playground
. . . . in the lunchroom
. . . . while attending specials
. . . . in the hallway
. . . . in the bathroom

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* Please rate each statement about your homeroom teacher.

  Most of the time Some of the time Not often Almost never
I like my teacher.
My teacher is fair.
My teacher cares about me.
I can ask my teacher for help.

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* Please rate the following statement about the principal.

  Most of the time Some of the time Not often Almost never
I like my principal.
My principal is fair.
My principal cares about me.
I can ask my principal for help.

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* Please rate each statement about the subjects and special classes you have at school.

  Most of the time Some of the time Not often Almost never
I am becoming a better reader.
My writing skills are getting better.
I understand math and use it to solve problems.
I understand how to use the scientific process to answer questions in science.
I see how learning about social studies helps me to be a better citizen.
I am learning more about music and how it connects to my life.
I am learning more about physical education and how it connects to my life.
My teacher uses different activities to help me learn.
My teacher helps make the things we study interesting and fun.
I am expected to do work on my own to show that I understand something.

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* Please rate each question about you as a learner.

  Most of the time Some of the time Not often Almost never
I like to learn.
I know what to do if I don't understand something.
An adult helps me when I don't understand something.
Homework helps my learning.
I feel comfortable participating during a lesson.

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