UHS Personal Connection Survey
Please complete the following survey. Please be honest with your responses and use proper language.
Thank you so much for your time!
Last Name *
Your answer
First Name *
Your answer
Your answer
Grade *
What period do you have Social Studies? *
Who is your S.S. teacher? *
Do you have a mentor in school/ or an adult you you can talk to for advice and support? *
If you have a mentor, or someone you can talk to in school, please list his or her name.
Your answer
If you have a mentor, or someone you can talk to, what is his/her role?
I participate in clubs before or after school to build relationships with: *
List all that apply:
If you don't participate in clubs or co-curricular activities, please state why:
Your answer
Which co-curricular club are you in? (If no club, skip question).
Your answer
What sport do you play in school? (If no sport, skip question).
Your answer
I want an adult in school I can check in with: *
Choose the one you prefer most.
Positive relationships in school are really important. If you could choose one adult in this building to talk to for more support and guidance, who would it be? (Choose any teacher, security guard, administrator, office staff, etc.) *
Your answer
Why did you choose this person? *
Your answer
Would you like to serve as a mentor to someone else younger than you? *
If yes, are you bilingual?
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