Professional Documents
Culture Documents
Questionnaire
Questionnaire
Directions:
This survey is voluntary and your responses will remain confidential. You can skip
questions and stop at any time. If you have questions during the survey, raise your hand
and your teacher can help you. This survey will take you about 10 minutes to complete.
Name:
Gender: Male Female Other
Grade: 11th or 12th
Employment:
I have a job I don’t have a job, but I am looking I don’t have a job and I am
not looking.
For each statement, select how often you display the behavior. You may select very
often, often, sometimes, rarely, or never for each item.
1. Communication
1. When I need help on an assignment, I am comfortable asking my teachers for
help Very Often Often Sometimes Rarely Never
2. I am able to communicate my needs.
Very Often Often Sometimes Rarely Never
3. When there is a disagreement with my friends, I am able to talk things out with them.
Very Often Often Sometimes Rarely Never
4. When discussing an issue with someone, I try to actively listen instead of planning
what I will say next.
Very Often Often Sometimes Rarely Never
5. I am able to express my feelings clearly.
Very Often Often Sometimes Rarely Never
6. I make sure that my message is heard and understood
Very Often Often Sometimes Rarely Never
7. When I am at school I feel confident in my ability to communicate with students and
teachers
Very Often Often Sometimes Rarely Never
2. Collaboration/Team Work
1. I am able to work with others to complete a project.
Very Often Often Sometimes Rarely Never
2. When working in a group, I give others the chance to talk and give their opinion.
Very Often Often Sometimes Rarely Never
3. I can give constructive criticism when working on a group project in class
Very Often Often Sometimes Rarely Never
4. I am able to share responsibility with others in my group
Very Often Often Sometimes Rarely Never
5. I am able to adjust my ideas after receiving feedback from the group
Very Often Often Sometimes Rarely Never
6. I make sure everyone in the group has an assignment to complete.
Very Often Often Sometimes Rarely Never
7. When I am at school I feel confident in my ability to work on group projects with other
students
Very Often Often Sometimes Rarely Never
4. Time Management
1. When it comes to managing my assignments, I know my priorities.
Very Often Often Sometimes Rarely Never
2. I consistently complete my homework.
Very Often Often Sometimes Rarely Never
3. I think about how long an assignment will take me before I begin to work on
it. Very Often Often Sometimes Rarely Never
4. I wait until my homework is done before I participate in other activities, like
watching TV or playing video games.
Very Often Often Sometimes Rarely Never
5. I consistently turn assignments in on time.
Very Often Often Sometimes Rarely Never
6. I feel confident in my ability to manage my time effectively
Very Often Often Sometimes Rarely Never
5. Goal Setting
1. I routinely set realistic goals for myself.
Very Often Often Sometimes Rarely Never
2. I track my progress until I’ve reached the goals I have set for myself.
Very Often Often Sometimes Rarely Never
3. I make short term goals that I can complete in a few weeks or months.
Very Often Often Sometimes Rarely Never
4. I make long term goals that will take a year or longer to complete.
Very Often Often Sometimes Rarely Never
5. I make my goals known to others so they can help me reach them.
Very Often Often Sometimes Rarely Never
6. I feel confident in my ability to set goals for myself
Very Often Often Sometimes Rarely Never