Student Info & Survey
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Your FIRST and LAST Name *
MUST type your first and last name
Your Section *
Choose the class section you are in
Your Year *
Choose the year of your Sixth Grade year
Explain to me the 1 thing you wish to share with me that sets you apart from everyone else in the world. *
It can be anything that is interesting about you that I should know!
Type the name of your father *
First and last name; not middle name!
Type the name of your mother *
First and last name; not middle name!
Choose the description that best describes you: *
Choose the description that best describes you: *
Choose the description that best describes you: *
List the names of your OLDER siblings
If you have no older siblings, type NONE
List the names of your YOUNGER siblings
If you have no younger siblings, type NONE
List the types of pets you have:
If you have no pets, type NONE
Select the name of the township/borough you live in: *
Do you have access to a computer at HOME? *
Do you have access to the internet at HOME? *
Do you have your own SMARTPHONE? *
What kind of SMARTPHONE do you have? *
Do you have your own TABLET (IPAD, KINDLE FIRE, etc.)? *
You are familiar with what a blog is. *
You are familiar with what an educational social media website is. *
Your Gender *
Choose the gender you are.
Multiple Choice Q: "I used to think school was pointless.  But now I think school is important and I need to learn so I can succeed." *
Choose the best answer below that describes how you feel about the statement.
Multiple Choice Q: "I used to think trying does not matter.  But now I believe that the more I try, the more I can succeed." *
Choose the best answer below that describes how you feel about the statement.
Multiple Choice Q: "I used to do what would make me popular with others in school.  But now I do what I want to do based on what I think is the right thing to do". *
Choose the best answer below that describes how you feel about the statement.
Multiple Choice Q: "I used to do what would make me popular with others in school.  I still find myself going along with certain friends in order to keep their "friendship"." *
Choose the best answer below that describes how you feel about the statement.
Multiple Choice Q: "I used to be someone who just came to school to pass the time.  But now I am someone who wants to be involved in the school and learn." *
Choose the best answer below that describes how you feel about the statement.
Q21  Would you rather be…
Clear selection
Q22  Explain why you chose your answer:
Out of the following choices, what would be your favorite:
Clear selection
Out of the following choices, what would be your favorite: *
Which team do you like more: *
Must choose one or the other
Which team do you like more: *
Must choose one or the other
Which team do you like more: *
Must choose one or the other
Which type of candy do you like best:
Clear selection
What is your favorite school subject? *
How do you prefer to learn? *
How do you prefer to work? *
How successful do you feel with your knowledge of science? *
Use a scale of 1 – 5 ;  1 = low, 3 = medium, 5 = high
LOW
HIGH
How comfortable do you feel with talking about science? *
Use a scale of 1 – 5 ;  1 = low, 3 = medium, 5 = high
LOW
HIGH
Determine the number that you feel shows your interest in science: *
Use the scale BELOW
UNINTERESTED
VERY INTERESTED
Overall, have you had a positive or negative experience with science? *
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This form was created inside of Schuylkill Valley School District.