Evaluation

The purpose of this survey is to tell what you have learned about how to succeed in school. Your ratings and comments will help us a great deal.

Directions: Please check the number that best indicates your feelings about each of the items below. Please write any comments you may have on the back of this evaluation form.

Student, please check one of these boxes:

As a student,

1. I have learned how successful people achieve their goals.

1 2 3 4 5

2. I have learned how to be comfortable and have fun while learning new things at school.

1 2 3 4 5

3. I have learned how to behave responsibly at school.

1 2 3 4 5

4. I have learned how to listen to my classroom teachers.

1 2 3 4 5

5. I have learned how to ask for help in school.

1 2 3 4 5

6. I have learned how to improve in my school work.

1 2 3 4 5

7. I have learned how to cooperate with other students at school.

1 2 3 4 5

8. I have learned how to cooperate with my teachers.

1 2 3 4 5

9. I have learned that school is a good place to be.

1 2 3 4 5

10. I have learned that I am a good person.

1 2 3 4 5

5=Strongly Agree

1=Strongly Disagree

Students, please do not write anything below

Teacher/counselor, please check one of these boxes:

Student Identification Number

Date

TOTAL SCORE