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2-5 Student Survey
Student Form
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* Indicates required question
1. My school is:
*
Choose
Addams
Ball Charter
Black Hawk
Butler
Dubois
Enos
Fairview
Feitshans
Graham
Harvard Park
Hazel Dell
Iles
Laketown
Lee
Lindsay
Marsh
Matheny-Withrow
McClernand
Ridgely
Sandburg
Southern View
Wilcox
2. What is your gender or gender identity?
*
Girl
Boy
Other
3. What is your race?
*
American Indian or Alaskan Native
Asian
Black or African American
Hispanic
Native Hawaiian or Pacific Islander
Two or more races
White
4. What grade are you in?
*
2
3
4
5
5. I like school.
*
Never
Sometimes
Often
Almost always
6. I feel like I do well in school.
*
Never
Sometimes
Often
Almost always
7. Adults at my school want me to do well.
*
Never
Sometimes
Often
Almost always
8. My school has clear rules for behavior.
*
Never
Sometimes
Often
Almost always
9. Adults at school treat me with respect.
*
Never
Sometimes
Often
Almost always
10. Good behavior is noticed at my school.
*
Never
Sometimes
Often
Almost always
11. I get along with other students.
*
Never
Sometimes
Often
Almost always
12. I feel safe in my classroom.
*
Never
Sometimes
Often
Almost always
12. I feel safe in the hallways, cafeteria and recess at school.
*
Never
Sometimes
Often
Almost always
13. Students treat each other with respect.
*
Never
Sometimes
Often
Almost always
14. There is an adult at my school who will help me if I need it.
*
Never
Sometimes
Often
Almost always
15. Students in my class behave so that teachers can teach.
*
Never
Sometimes
Often
Almost always
16. I meet in circles or class meetings at school.
*
Daily
Weekly
Monthly
Never
17. Circles help me get to know my classmates and teachers.
*
Never
Sometimes
Often
Almost always
We don't use circles in our class.
18. There is a place where I can go if I need to calm down.
*
Never
Sometimes
Often
Almost always
19. I feel like I am in trouble if I move to the safe seat.
*
Never
Sometimes
Often
Almost always
We don't have a Safe Seat in my class.
20. I feel like I am in trouble if I move to the buddy room.
*
Never
Sometimes
Often
Almost always
We don't have a Buddy Room at my school.
21. I participate in a Welcoming Ritual.
Daily
Weekly
Monthly
Never
I don't know what a Welcoming Ritual is.
Clear selection
22. I participate in an Optimistic Closure or a positive check out at the end of the day.
Daily
Weekly
Monthly
Never
I don't know what an Optimistic Closure is.
Clear selection
23. My teacher teaches 2nd Step.
*
Daily
Weekly
Monthly
Never
I don't know what the 2nd Step Program is.
Submit
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