*  

 

Select Your School:
Select an option West Middle School East Middle School Alternative School High School

 

 

Student ID:

 *  

 

1. Do you have a best friend at school?
Yes Sometimes No

 *  

 

2. Is there an adult in your life that cares about your future?
Yes Sometimes No

 *  

 

3. In the last seven days, have you received recognition or praise for doing good schoolwork?
Yes No

 *  

 

4. Do you take part in school activities such band, clubs, etc.?
Yes Sometimes No

 *  

 

5. Do you take part in school sports teams?
Yes Sometimes No

 *  

 

6. Do you take part in community activities such as scouts, rec. teams, youth clubs, etc.?
Yes Sometimes No

 *  

 

7. In the last month, did you volunteer your time to help others?
Yes No

 *  

 

8. Do you feel safe in this school?
Yes Sometimes No

 *  

 

9. Does your school set clear rules on using drugs at school?
Yes Sometimes No

 *  

 

10. Does your school set clear rules on bullying or threatening other students at school?
Yes Sometimes No

 *  

 

11. Do your parents or family talk with you about the problems of tobacco, alcohol and drug abuse?
Yes Sometimes No

 *  

 

12. Will you graduate from high school?
Yes Not Sure No

 *  

 

13. Do you plan to attend college or trade school after you graduate?
Yes Not Sure No

 *  

 

14. Will you find a good job after you graduate?
Yes Not Sure No

 *  

 

15. Can you find a lot of ways around any problem?
Yes Sometimes No

 *  

 

16. Do you make good grades?
Yes Sometimes No

 *  

 

17. Do problems outside of school affect your grades?
Yes Sometimes No

 *  

 

18. Do you have enough energy to keep up with your school work?
Yes Sometimes No

 *  

 

19. Do you get into trouble at school?
Yes Sometimes No

 *  

 

20. Have you skipped school in the past year?
Yes Sometimes No

 

 

21. What do you like about this school?

 

 

22. What do you wish was different about this school?