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For each item on this survey circle one of the following choices: NO, no, yes, YES. Circle the choice that
best describes your view of yourself as a student. For each item on the survey, you have the option to
explain your answer on the lines if you would like to do so.
1. I care less about school since I entered this class
NO no yes YES
2. This class makes me care less about others
NO no yes YES
3. I’m tired of school
NO no yes YES
4. When I wake up in the morning I don’t want to go to school
NO no yes YES
5. Being liked is more important than doing well in my class
NO no yes YES
6. I like school
NO no yes YES
7. I stay calm when other kids in my class have problems
NO no yes YES
8. I know what I am supposed to do in my class
NO no yes YES
9. Goals in my classroom are clear
NO no yes YES
10. School gets in the way of fun times
NO no yes YES
11. Rules get in the way of getting my work done
NO no yes YES
12. I have to do things in my class that I don’t think are right
NO no yes YES