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1. All students are capable of success no matter what.

  1 Strongly disagree/disbelieve 2 3 4 5 6 7 8 9 10 Stongly agree/believe
On a scale of 1-10 "1" representing strongly disagree/disbelieve up to "10" representing strongly agree/believe check the number which best represents your feelings or belief.

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2. Some students may not succeed due to negative family, social, or other environmental influences.

  1 Stongly disagree/disbelieve 2 3 4 5 6 7 8 9 10 Stongly agree/believe
On a scale of "1-10" similiar to the first question please check the number which best represents your feeling or belief.

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3. Every person employed (faculty, administrators, support staff) by your school or organization believes all students can succeed no matter what.

  1 Strongly disagree/disbelieve 2 3 4 5 6 7 8 9 10 Stongly agree/believe
Similiar to the previous questions please check the number which best represents your feelings or belief.

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4. Other adults (parents/neighbors/business owners/workers) within your attendance area/community believe that all students can succeed no matter what.

  1 Stongly disagree/disbelieve 2 3 4 5 6 7 8 9 10 Stongly agree/believe
Similiar to the previous questions please check the number which best represents your feeling or belief.

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5. It is a priority of your school/organization that each student have a meaningful relationship with a teacher, administrator or other staff.

  Strongly disagree/disbelieve 2 3 4 5 6 7 8 9 Strongly agree/believe
Similiar to the previous questions please check the number which best represents your feeling or belief

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6. What percentage of students in your school/organization do you believe have a meaningful relationship with a teacher, administrator, and/or staff member?

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7. What percentage of students in your school/organization do you believe will succeed as an adult?

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8. What percentage of students in your school/organization do you believe are hopeful and excited about their future?

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9. Is goal setting taught to students in your school/program/organization?

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10. If your school/program/organization teaches goal setting which areas are its primary focus (select all that apply)?

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11. Overall, I believe our administrators, teachers, staff and students feel that our school/organization is a place where all students can experience success.

  Strongly disbelieve/disagree Strongly believe/agree
On a scale of 1-10 please select the score which best represents your feelings.

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