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Client Survey
Directions: Read each statement. Respond to the statements by selecting the response (YES, SOMETIMES, or NO) that best describes how you feel about the statement.
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* Indicates required question
Teacher Name
*
Your answer
School Year
*
Your answer
Homeroom Teacher
*
Your answer
My teacher listens to me.
*
Choose
YES
SOMETIMES
NO
My teacher gives me help when I need it.
*
Choose
YES
SOMETIMES
NO
My teacher shows us how to do new things.
*
Choose
YES
SOMETIMES
NO
My teacher encourages me to evaluate my own learning.
*
Choose
YES
SOMETIMES
NO
I am able to do the work in class.
*
Choose
YES
SOMETIMES
NO
I learn new things in my class.
*
Choose
YES
SOMETIMES
NO
I feel safe in this class.
*
Choose
YES
SOMETIMES
NO
My teacher uses many ways to teach.
*
Choose
YES
SOMETIMES
NO
My teacher explains how my learning can be used outside of school.
*
Choose
YES
SOMETIMES
NO
My teacher explains why I get things wrong on my work.
*
Choose
YES
SOMETIMES
NO
My teacher shows respect to all students.
*
Choose
YES
SOMETIMES
NO
My teacher demonstrates helpful strategies or skills for my learning.
*
Choose
YES
SOMETIMES
NO
There are opportunities to reflect on my learning in my class.
*
Choose
YES
SOMETIMES
NO
My teacher allows me to make some choices about my learning.
*
Choose
YES
SOMETIMES
NO
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