Student Questionnaire * Required

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1 Student Questionnaire * Required 1. Select your current grade * 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade 2. Indicate how many years you have been at this school: * less than one year one year two years three years more than three years This section includes questions with responses ranging from (lowest), followed by,, and Strongly (highest.) Please select the most appropriate response to each question. 3. (110) I feel welcome and safe at my school. * Strongly 0dyCMNSn643VqXNiUfj55hxzNW7DjcojjjqVk/printform 1/10

2 4. (110) (120) I have NOT seen or been in any fights at my school in the last 6 months. * Strongly 5. (110) I know what to do in case of an emergency at my school. * Strongly 6. (120) Behavior problems DO NOT interfere with learning in my classes. * Strongly 7. (120) I have received a reward (other than verbal praise) for following the rules in the last 2 months. * Strongly 8. (120) I have been taught the expectations or rules about how to behave at my school. * Strongly 0dyCMNSn643VqXNiUfj55hxzNW7DjcojjjqVk/printform 2/10

3 9. (120) My hard work has always been recognized and rewarded at school. * Strongly 10. (140) Our school is clean and looks nice. * Strongly 11. (210) The school administrators (principal and assistant principal/administrative assistant) believe that I will do well in school. * Strongly 12. (210) I am encouraged by school administrators (principal and assistant principal/administrative assistant) to do well in school. * Strongly 13. (210) My teachers motivate me to do my best work in class. * Strongly 0dyCMNSn643VqXNiUfj55hxzNW7DjcojjjqVk/printform 3/10

4 14. (210) My teachers believe that I will do well in school. * Strongly 15. (210) My teachers expect EVERYONE to succeed. * Strongly 16. (210) (220) My teachers allowed me to suggest ideas for classroom procedures and routines. * Strongly 17. (230) I get help from teachers, counselors, or other adults when I need it. * Strongly 18. (240) I enjoy coming to school. * Strongly 0dyCMNSn643VqXNiUfj55hxzNW7DjcojjjqVk/printform 4/10

5 19. (250) I know about or participated in after school tutoring programs in the last 6 months. * Strongly 20. (250) (520) I have easy access to extra reading materials in my school. * Strongly 21. (250) Students in my class have access to computers and the Internet. * Strongly 22. (250) My classroom is a comfortable place to learn. * Strongly 23. (250) My teachers have assigned different projects related to my culture. * Strongly 0dyCMNSn643VqXNiUfj55hxzNW7DjcojjjqVk/printform 5/10

6 24. (250) The school administrators (principal and assistant principal/administrative assistant) are often seen around the school talking with students. * Strongly 25. (310) My parents help me with my school work. * Strongly 26. (320) My parents have visited my school for after school activities. * Strongly 27. (320) My parents know what is going on in my school. * Strongly 28. (510) My teachers encourage me to participate in class discussions and to defend my opinions. * Strongly 0dyCMNSn643VqXNiUfj55hxzNW7DjcojjjqVk/printform 6/10

7 29. (510) If I am having trouble learning something, my teachers usually find another way to help me understand it. * Strongly 30. (510) My teachers encourage me to participate in class discussions and to defend my opinions. * Strongly 31. (520) I understand most of the materials presented by my teacher during my regular classes (math, reading, English, social studies, and science) in order to do well on state tests. * Strongly 32. (520) I understand my homework and other assignments. * Strongly 33. (520) My classroom has visual aids (posters, maps, bulletin boards) that help me understand my lessons. * Strongly 0dyCMNSn643VqXNiUfj55hxzNW7DjcojjjqVk/printform 7/10

8 34. (520) I feel prepared at the end of a school year to move to the next grade. * Strongly 35. (530) My teachers ask me to show what I have learned in different ways (performance tests, quizzes, projects, portfolios, presentations.) * Strongly 36. (530) My teachers tell me how I am doing and how I can improve my knowledge to earn better grades. * Strongly 37. (540) My teachers check my homework regularly. * Strongly 38. (540) My school has recreation or sports equipment for me to use during P.E. or recess. * Strongly 0dyCMNSn643VqXNiUfj55hxzNW7DjcojjjqVk/printform 8/10

9 39. (540) My school gives us recess/break time during the school day. * Strongly Wellness Survey 40. (2000) I eat breakfast every morning. * Yes Sometimes No 41. (2000) How would you describe your overall health? * Excellent Very Good Good Fair Poor 42. (2000) How healthy do you think you eat? * Very healthy, I make sure to eat balanced meals Mostly healthy, I try to eat healthy 4 5 days per week Not sure Less healthy than I should Not healthy 43. (2000) How often do you exercise each week on average? * 7 days per week 5 6 days per week 3 4 days per week 1 2 days per week 0 days per week 0dyCMNSn643VqXNiUfj55hxzNW7DjcojjjqVk/printform 9/10

10 44. (2000) What type of exercise do you do? * (Choose all that apply) Check all that apply. I participate on at least 1 sports team I go to a gym, use gym equipment, or take an exercise class I play outside with friends I exercise on my own I work hard in my P.E. class and often break a sweat I do not exercise 45. (2000) On average each day, how much time do you spend watching TV or playing video games? * None Less than 1 hour About 1 hour About 2 hours 3 or more hours Powered by 0dyCMNSn643VqXNiUfj55hxzNW7DjcojjjqVk/printform 10/10

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