Artifact 6a

Student Perception survey to small NETS intervention Fall 2012

The following survey will be used to determine how you perceive your experience and learning at East Middle
School. Your answers will be handled with the utmost confidentiality.

Please DO NOT write your name on this survey.

We would appreciate your honest answers to the following questions. Please indicate the answer that most
accurately describes your feelings about each statement by circling the number response as indicated below:


Strongly Agree Undecided Disagree Strongly
agree disagree


1. I like school. 1 2 3 4 5


2. I am putting forth my best effort at school. 1 2 3 4 5


3. I feel I am successful academically. 1 2 3 4 5


4. I have positive relationships with teachers. 1 2 3 4 5


5. I have positive relationships with other students. 1 2 3 4 5





We appreciate your candid responses and thank you for your time