How old are you?

11 or younger

12

13

14

15

16

17

18 or older

What is your gender?

Male

Female

Which statement below best describes your race/ethnicity?

Black or African American

White (Non-Hispanic)

Hispanic, Latino, or Latina

Asian or Pacific Islander

Other

Which statement best describes your living situation?

I live with both parents

I live with one parent

I share time with both parents as they do not reside in the same house

I live with a grandparent, aunt, cousin, sister, brother

I live with a friend

I live alone

I live in a Homeless Shelter

Foster Care

I give my best effort in the things that I do.

Always

Almost Always

Sometimes

Rarely

Never

I admit and accept responsibility for my mistakes.

Always

Almost Always

Sometimes

Rarely

Never

I believe that my future is bright and promising.

Strongly Agree

Agree

Don't know

Disagree

Strongly Disagree

I tell the truth.

Always

Almost Always

Sometimes

Rarely

Never

I feel that I am smart.

Strongly agree

Agree

Don't know

Disagree

Strongly Disagree

I feel that people love and care about me.

Strongly agree

Agree

Don't know

Disagree

Strongly Disagree

I feel alone

Always

Almost Always

Sometimes

Rarely

Never

I feel angry

Always

Almost Always

Sometimes

Rarely

Never

I shy away from things that are difficult or demanding.

Always

Almost Always

Sometimes

Rarely

Never

I work hard to achieve my goals.

Always

Almost Always

Sometimes

Rarely

Never

I like helping other people.

Always

Almost Always

Sometimes

Rarely

Never

What grade are you currently in?

6

7

8

9

10

11

12

Have you ever been held back in a grade and/or are you short of required credits?

Yes

No

Describe your Alternative Educational Placement.

Voluntary (My parents and/or I chose to have me attend)

Administrative (I was assigned to the Alternative Education School by the District)

Which statement below best describes the reason for your placement?

Pregnancy

A serious violation of the Code of Student Conduct (i.e., Battery, Assault, Drug, Weapon)

Poor academic grades, attendance, and/or behavior

Off-Campus Violation (i.e., Arrested for incident that occurred after school hours)

When do you expect to return to your home school?

9 weeks

18 weeks

27 weeks

1 full school year

Never

What type of grades do you earn in school?

Mostly High Grades (A's and B's)

Mostly Passing Grades (C's)

Mostly Poor or Failing Grades (D's and F's)

How much time do you spend studying or doing homework each day?

None

1/2 Hour

2 Hours

3 Hours or more

My teachers at school really care about me as a person and want me to be successful in school.

Strongly Agree

Agree

Don't know

Disagree

Strongly Disagree

My teachers at school encourage me to put forth my best effort.

Strongly Agree

Agree

Don't know

Disagree

Strongly Disagree

I come to school prepared to learn (materials, homework, textbook, and attitude).

Always

Almost

Sometimes

Rarely

Never

Staff at my school show clear expectations for my learning, attendance, and behavior.

Always

Almost

Sometimes

Rarely

Never

I believe that I will graduate from high school.

Strongly Agree

Agree

Don't Know

Disagree

Strongly Disagree

I believe that I am capable of attending and succeeding in college.

Strongly Agree

Agree

Don't Know

Disagree

Strongly Disagree

I believe that I will live a productive and positive life.

Strongly Agree

Agree

Don't Know

Disagree

Strongly Disagree

I feel that any future success that I experience in my life will be related and tied to my getting a good education.

Strongly Agree

Agree

Don't Know

Disagree

Strongly Disagree

I believe that my life is important and valuable to others around me.

Strongly Agree

Agree

Don't know

Disagree

Please tell us how we can better serve you and improve your educational experience at school.