Student Questionnaire
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Email *
Student Name *
Today's date *
MM
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DD
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YYYY
Birthdate *
MM
/
DD
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YYYY
What is the highest grade your parents have completed? *
What classes are you taking? What do you want us to help you with? *
What grade are you in? *
Do you Qualify for Free Lunch *
How do you feel about school? *
I hate it
I love it
What do you like about school and what don't you like about school? *
What are your plans after high school? *
Required
I feel bullied at school *
I feel bullied out of school *
Clear selection
Clear selection
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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