Student Questionnaire
Full Name *
Your answer
Date *
MM
/
DD
/
YYYY
Date of Birth *
MM
/
DD
/
YYYY
Ethnicity *
Your answer
Parents Highest Level of Education *
Your answer
Do you Qualify for Free Lunch *
How do you feel about school from 1-10 *
I hate it
I love it
What classes/ grades do you have now? *
Your answer
What are your plans after high school? *
I feel bullied at school *
I feel bullies out of school *
I don't fit in at school *
Nobody understands what I am going through *
I have people I can talk to *
I like my classmates *
I look forward to school *
I feel comfortable at school *
I think people at school like me *
I feel comfortable asking teachers for help in school *
I think that what I learn in school is useful *
I think that what I learn in school is going to help me throughout my life *
College is an option for me *
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