Student Surveys

OMB #:

Expiration Date:

Evaluation of the DC Opportunity Scholarship Program

Elementary School (Grades 4-5)

Student Questionnaire

Spring 2013

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number.  The valid OMB control number for this information collection is xxxx-xxxx.  Public reporting burden for this collection is estimated to average 15 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. Completion of this survey is mandatory. SOAR Act Sec. 3009(a)(3)(C).  .

Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the U.S. Department of Education, 400 Maryland Avenue, S.W., LBJ, Room 2E117, Washington, DC 20210-4537 or send electronically through the Federal eRulemaking  Portal at http://www.regulations.gov by selecting the Docket ID number.

Please answer all the questions.

Part 1: About You

This first section asks questions about you.

Q1. Are you a ….

( Check one)

Boy or ¹

Girl? ²

Q2. How often do you read books that are not assigned by your teacher?

( Check one)

Every day ¹

Most days ²

Some days ³

Never ⁴

Q3. How far do you expect to go in school?

( Check one)

Less than high school completion ¹

Complete a high school diploma, GED or alternative high school credential ²

Complete a certificate or diploma from a school that provides occupational training ³

Complete an Associate’s degree ⁴

Complete a Bachelor’s degree ⁵

Complete a Master’s degree ⁶

Complete a Ph.D., M.D., law degree, or other high level professional degree ⁷

Q4. During this year, have you done any of the following?

( Check yes or no on each row)

	Yes	No
Participated in groups or activities at your church (like choir or youth group)	1	2
Participated in a team or club (like little league or girl scouts/boy scouts) in your community	1	2
Participated in a team or club (like sports, music, or dance) at your school………………………	1	2
Participated in a community service activity or volunteer work at your school or in your community	1	2
Gone to religious services	1	2

Q5. On a regular school day, how long are you at home after school with no adult there?

( Check one)

None ⁰

Less than 1 hour ¹

1-2 hours ²

2-3 hours ³

More than 3 hours ⁴

Q6. Do any of the following encourage you to work harder in school?

( Check one box on each row)

	A Lot	A Fair Amount	A Little Bit	Not At All
a. Pressure from my parents	1	2	3	4
b.Pleasing my parents by getting good grades	1	2	3	4
c.Teacher expectations	1	2	3	4
d.Pleasing my teacher	1	2	3	4
e.Encouragement from my teachers	1	2	3	4
f.Learning the material	1	2	3	4
g.Interest in the subject	1	2	3	4
h.Keeping up with my friends	1	2	3	4
i.Getting a better job	1	2	3	4
j.Getting into college	1	2	3	4
k.Pressure from my friends	1	2	3	4
l.Not embarrassing my family	1	2	3	4

Part 2: About Your School and Classes

This section asks questions about your school and classes, support from teachers and other adults in the school and other students’ attitudes.

Q7. Do you agree or disagree with these statements about your school?

( Check one box on each row)

	Agree strongly	Agree	Disagree	Disagree strongly
a.Students are proud to go to this school	1	2	3	4
b.Students at this school have a lot of opportunities to learn	1	2	3	4
c.Rules of behavior are strict	1	2	3	4
d.People at my school are supportive of each other	1	2	3	4
e.I feel lonely at my school	1	2	3	4
f.I enjoy going to school	1	2	3	4
g.There is respect, among students and teachers, for other religions and cultures, at my school	1	2	3	4
h.Students are taught to be kind and responsible for their actions	1	2	3	4

Q8. Overall, how safe do you feel your school is?

Very safe ¹

Somewhat safe ²

Not safe ³

Q9. Did the following ever happen to you at school this year?

( Check one box on each row)

	Never	Once or twice	3 times or more
Had something stolen from your desk, locker, or other place	1	2	3
Been forced by other kids to give them money or my stuff	1	2	3
Been offered drugs	1	2	3
Been physically hurt by another student	1	2	3
Been threatened with physical harm	1	2	3
Seen anyone with a real or toy gun or knife at school	1	2	3
Been bullied at school	1	2	3
Been called a bad name	1	2	3

Q10. Do you agree or disagree with these statements about the teachers and other adults at your

school?

( Check one box on each row)

	Agree strongly	Agree	Disagree	Disagree strongly
At my school, there is a teacher or some other adult who…
listens to me when I have something to say	1	2	3	4
really cares about me	1	2	3	4
believes I will be a success	1	2	3	4
always wants me to do my best	1	2	3	4
tells me when I do a good job	1	2	3	4
notices when I’m not there	1	2	3	4
talks to me about problems I have at home or with my friends	1	2	3	4
motivates me to work hard	1	2	3	4

Q11. During the current school year (2012-2013), have teachers and other school staff provided you with support? If they did, was it helpful?

( Check two boxes on each row)

	Yes	No	Very Helpful	Somewhat Helpful	Not Helpful
Extra help before or after school in academic subjects?	1	2	1	2	3
Academic instruction on weekends?	1	2	1	2	3

Q12. Do you agree or disagree with these statements about the students at your school?

( Check one box on each row)

	Agree strongly	Agree	Disagree	Disagree strongly
At my school, students…
behave well with the teachers	1	2	3	4
neglect their homework	1	2	3	4
often make fun of each other	1	2	3	4
often disrupt class	1	2	3	4
who misbehave often get away with it	1	2	3	4

Q13. What overall grade would you give your school?

( Check one)

A-Excellent ¹

B-Good ²

C-Fair ³

D-Unsatisfactory ⁴

F-Failing ⁵

Q14. During this year, have you taken classes in?

( Check yes or no on each row)

	Yes	No
Art, music, or dance lessons	1	2
Foreign language classes	1	2
Religion	1	2
Sports exercise or gymnastics	1	2

Q15. How much do you agree or disagree with the following statements about your teacher? Remember, your teacher and your principal will not see any of the answers you provide. Your teacher…

( Check one box on each row)

	Agree strongly	Agree	Disagree	Disagree strongly
Values and listens to students’ ideas	1	2	3	4
Treats students with respect	1	2	3	4
Treats every student fairly	1	2	3	4
Thinks every student can be successful	1	2	3	4
Thinks mistakes are okay as long as all students learn	1	2	3	4
Treats some kids better than other kids	1	2	3	4
Makes learning interesting	1	2	3	4
Treats males and females differently	1	2	3	4
Makes things easy to understand	1	2	3	4
Goes through the materials too quickly	1	2	3	4
Only pays attention to the smart students	1	2	3	4
Only pays attention to students who are struggling	1	2	3	4
Helps students if they ask a question	1	2	3	4

Q16. To what extent do you understand what is being taught in class?

None of the time ¹

Less than half the time ²

About half the time ³

More than half the time ⁴

All the time ⁴

Q17. How many students are in your class? _______________________

(your best guess is fine)

Q18. On average, how many minutes do you spend doing homework per day?

( Check one)

0 minutes ⁰

1 to 10 minutes ¹

11 to 20 minutes ²

^{21 to 30 minutes} ³

31 to 60 minutes ⁴

More than 60 minutes ⁵

Part 3: About Your Friends

This section asks questions about your friends.

Q19. How many of your close friends do your parents know by name?

( Check one)

All of them ¹

Most of them ²

Some of them ³

None of them ⁴

Q20. Think about your close friends. How many of them do the following?

( Check one box on each row)

	All of them	Some of them	A few of them	None
a.Use bad language regularly	1	2	3	4
b.Smoke cigarettes regularly	1	2	3	4
c.Drink beer or alcohol regularly	1	2	3	4
d.Use illegal drugs regularly	1	2	3	4
e.Talk about college and careers	1	2	3	4
f.Talk about classes in school and what they are learning	1	2	3	4
g.Talk about what could be done to improve the neighborhoods and the city	1	2	3	4

Q21. How important do your school friends think it is to:

( Check one box on each row)

	Very important	Somewhat important	Not too important	Not at all important
a.Study hard to get good grades	1	2	3	4
b.Talk/hang out with friends	1	2	3	4
c.Participate in class	1	2	3	4

Q22. Which group of friends do you listen to the most when you think about school?

( Check one box)

Friends from your neighborhood ¹

Friends from school ²

My neighborhood friends are the same
as my school friends ³

Thank you, please hand in your survey.