Student Survey
This information collection is authorized by OMB # 0704-0437 and RCS # [INSERT ONCE RECEIVED]. The public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Comments can be sent regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate [OMB control # 0704-0437]. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Your responses to these questions are voluntary and there is no penalty if you choose not to respond. However, maximum participation is encouraged so that the data will be complete and representative. The purpose of these group interviews is to identify school-related issues to be addressed through the school improvement process. We will not collect or record information that could be used to identify specific individuals that participate in these interviews. In any release of results, no information will be disclosed that could be used to identify specific subgroups of individuals if that information would reveal the identity of the participants.
NOTE: EACH SCHOOL WOULD CHOOSE ONLY 3-5 OF THE FOLLOWING QUESTIONS FOR STUDENTS, DEPENDENT ON THE FOCUS OF THEIR INDIVIDUAL SCHOOL IMPROVEMENT PLAN, AND THE GRADE LEVELS OF STUDENTS.
Student Achievement
1. On a scale of 1-5, with 5 being “Very Good” and 1 being “Very Poor” how well do you think you are performing in each of the following areas? (Schools would provide as choices only the areas below they are focusing on from the following list).
|
Very Poor
1 |
Poor
2 |
Neither Poor nor Good 3 |
Good
4 |
Very Good
5 |
Reading comprehension |
O |
O |
O |
O |
O |
Writing |
O |
O |
O |
O |
O |
Oral communication |
O |
O |
O |
O |
O |
Listening |
O |
O |
O |
O |
O |
Math computation |
O |
O |
O |
O |
O |
Math reasoning/problem solving |
O |
O |
O |
O |
O |
Science |
O |
O |
O |
O |
O |
Social Studies/History |
O |
O |
O |
O |
O |
Health/Physical Education |
O |
O |
O |
O |
O |
Foreign Language |
O |
O |
O |
O |
O |
Art |
O |
O |
O |
O |
O |
Music |
O |
O |
O |
O |
O |
Problem Solving |
O |
O |
O |
O |
O |
Reasoning/Inquiry |
O |
O |
O |
O |
O |
Using technology |
O |
O |
O |
O |
O |
Leadership |
O |
O |
O |
O |
O |
Personal Discipline/Self-control |
O |
O |
O |
O |
O |
Study Skills |
O |
O |
O |
O |
O |
On a scale of 1-5, with 5 being “Very Good” and 1 being “Very Poor,” please rate the quality of instruction your school provides in each of the following subject areas.
|
Very Poor
1 |
Poor
2 |
Neither Poor nor Good 3 |
Good
4 |
Very Good
5 |
Reading |
O |
O |
O |
O |
O |
Writing |
O |
O |
O |
O |
O |
Mathematics |
O |
O |
O |
O |
O |
Science |
O |
O |
O |
O |
O |
Social Studies |
O |
O |
O |
O |
O |
3. Pick the THREE areas below where you feel you need the most help. (Place checks by the three areas where you feel you need the most help). (Schools would provide as choices only those areas of focus from the following list).
Reading comprehension |
□ |
|
Reasoning/Inquiry |
□ |
Writing |
□ |
|
Using technology |
□ |
Oral communication |
□ |
|
Leadership |
□ |
Listening |
□ |
|
Personal Discipline/Self-control |
□ |
Math computation |
□ |
|
Foreign Language |
□ |
Math reasoning/problem solving |
□ |
|
Art |
□ |
Science |
□ |
|
Music |
□ |
Social Studies/History |
□ |
|
Problem Solving |
□ |
Health/Physical Education |
□ |
|
|
|
4. When I need help with my school work, someone at my school is available to help me. (Please mark one).
O Strongly agree
O Agree
O Undecided
O Disagree
O Strongly disagree
5. This school is preparing me well for the next grade. (Please mark one).
O Strongly agree
O Agree
O Undecided
O Disagree
O Strongly disagree
6. [FOR HIGH SCHOOL STUDENTS ONLY] This school is preparing me well for what I want to do after high school. (Please mark one).
O Strongly agree
O Agree
O Undecided
O Disagree
O Strongly disagree
7. [FOR HIGH SCHOOL STUDENTS ONLY] This school is preparing me well for the world of work. (Please mark one).
O Strongly agree
O Agree
O Undecided
O Disagree
O Strongly disagree
8. When I graduate I am confident in my:
|
Yes |
No |
Ability to write |
O |
O |
Ability to read |
O |
O |
Ability to do mathematics |
O |
O |
Ability to present information |
O |
O |
Technology skills |
O |
O |
Safe Environment
9. My school maintains good discipline. (Please mark one).
O Strongly agree
O Agree
O Undecided
O Disagree
10. How safe do you feel at school? (Please mark one).
O Very safe [Skip to Question 12]
O Safe [Skip to Question 12]
O Undecided [Skip to Question 12]
O Unsafe
O Very Unsafe
11. [FOLLOWUP QUESTION ONLY FOR THOSE WHO ANSWERED “UNSAFE” TO PRIOR QUESTION] How often do you feel unsafe when you are at school? (Please mark one).
O Never
O Rarely
O Some days
O Most days
O Every day
12. On a scale of 1-5, with 5 being very safe and 1 being unsafe, how safe do you feel in the following locations in your school?
|
Very unsafe 1 |
Unsafe
2 |
Neither safe nor Unsafe 3 |
Safe
4 |
Very Safe
5 |
Does Not Apply |
a. School Hallways |
O |
O |
O |
O |
O |
|
b. Classrooms |
O |
O |
O |
O |
O |
|
c. School Lunchroom |
O |
O |
O |
O |
O |
|
d. School Playground |
O |
O |
O |
O |
O |
|
e. School Parking Lot |
O |
O |
O |
O |
O |
|
f. School Restrooms |
O |
O |
O |
O |
O |
|
g. School Buses |
O |
O |
O |
O |
O |
O |
h. Walking to and from school |
O |
O |
O |
O |
O |
O |
i. Other (please specify): ___________ |
O |
O |
O |
O |
O |
|
13. My school deals appropriately with students who bully other students. (Please mark one).
O Strongly agree
O Agree
O Undecided
O Disagree
O Strongly disagree
14. What can teachers and administrators do to help stop bullying?(Check all that apply).
Supervise the playground and halls better
Establish rules against bullying
Enforce rules against bullying
Teach kids how to get along better
Other ______________________________________
15. Discipline problems are handled quickly at my school. (Please mark one).
O Strongly agree
O Agree
O Undecided
O Disagree
O Strongly disagree
16. Discipline problems are handled fairly at my school. (Please mark one).
O Strongly agree
O Agree
O Undecided
O Disagree
O Strongly disagree
School Partnerships
17. Does your school openly invite parent(s)/guardian(s) to take part in school related events? (Examples might include parent nights, sports, or field trips.) (Please mark one).
O Yes
O No
O No answer
18. How often do your teachers communicate with your parent(s)/guardian(s) (by phone, email, classroom newsletter, etc.)? (Please mark one).
O At least once a week
O At least once a month
O Once or twice a year
O No answer
| File Type | application/msword |
| File Title | Please indicate whether you agree or disagree with the following statements |
| Author | user |
| Last Modified By | pltoppings |
| File Modified | 2007-01-30 |
| File Created | 2007-01-23 |