Inclusivity

Perception Survey
Please be as honest: these answers will be confidential and not shared with anyone.

HOW I FEEL ABOUT MYSELF (please check one box for each statement)
“Yes, “Sure, “No, not “Absolutely
definitely!” mostly.” really.” not!”

1. I feel like I belong at this school.

2. I am friends with people who are

different than me.

3. I treat every other student with

respect.

4. I can be myself at school.

HOW I FEEL ABOUT OTHER STUDENTS (please check one box for each statement)
“Yes, “Sure, “No, not “Absolutely
definitely!” mostly.” really.” not!”

5. I like my classmates.

6. I am like other students.

7. I like other students who are different

than me.

8. I include other students in activities at

school.

HOW OTHER STUDENTS FEEL ABOUT ME (please check one box for each statement)
“Yes, “Sure, “No, not “Absolutely
definitely!” mostly.” really.” not!”

9. Other students support me at

school.

10. Other students are friendly to me.

11. Other students treat me with

respect.

12. Other students like who I am.

HOW MY TEACHERS FEEL ABOUT ME & OTHER STUDENTS (please check one box for each
statement)
“Yes, “Sure, “No, not “Absolutely
definitely!” mostly.” really.” not!”

13. My teacher supports me at school.

14. My teacher tells me I can be successful.

15. My teacher likes everyone in the class.

16. My teacher tells my classmates they

can be successful.

Optional Latinx Identity Perception Questions

OTHER PERCEPTION QUESTIONS (please check one box for each statement)
“Yes, “Sure, “No, not “Absolutely
definitely!” mostly.” really.” not!”

17. I see examples of Hispanic role models or

mentors in my life.

18. People view being Hispanic as a strength.

19. I like being Hispanic/Latino/Latina.

20. I am proud to be bilingual.

21. I want to go to college.

22. .I know a few career I’d like to have.

23. At school, there is celebration and

recognition of my culture.

24. I feel like I have lots of options for my

future.

25. I have many goals I’d like to achieve.

Any other thoughts related to questions above (optional):