School Survey - Please complete honestly and to the best of your ability. Thank you.

1. When did you graduate high school/complete your formal “grade school” education ?

____ Within the last 10 years_____ Between 31-40 years

____ Between 11-20 years _____ Between 41-50 years
____ Between 21-30 years _____ Over 50 years

2. What was your attitude towards your school experience in general? (Please circle one.)

Very positive somewhat positive neutral somewhat negative very negative

3. What was your general attitude towards academic classes?

Very positive somewhat positive neutral somewhat negative very negative

4. Did you participate in any extracurricular activities related to or in your school/district? This includes athletic and
non-athletic. If YES, how many?

5. If the answer to number four was “NO,” why did you not participate in school-related extracurricular activities?
(Please circle response that best explains.)

A. There was nothing of my interest to participate in, or I would.

B. I had no desire to participate in any extra curricular activities.
C. I participated in activities and groups, but they were not school-based.
D. I had other responsibilities (family, job) outside of school.
E. Other (please list if possible)___________________________________________

Please rate the following statements to the best of your ability and circle a response.
SA = Strongly Agree A = Agree D = Disagree SD = Strongly Disagree N = Neutral

6. School Based Extracurricular Activities had an SA A D SD N

effect on my attitude about school.

7. Personal academic performance had an effect on SA A D SD N

my attitude about school.

8. Other students had an effect on my attitude about school. SA A D SD N

9. Certain teachers had an effect on my SA A D SD N

attitude about school.

10. I felt “connected” or pride in my individual SA A D SD N

School or district.

Please put in order from 1 to 5 the influence each variable had on your attitude towards school.
1= Greatest Effect to 5 = least effect.

Extracurricular Activities ________ Academic Performance _______ Other students ____

Teachers _______ Family ________

Thank you!