Back to School Engagement Survey

Please complete this back to school survey. The more I know about you, the easier it will be for me to help you grow your abilities.
Name: 


A red asterisk (*) indicates required questions.

  1. Who are some of your heroes?*


  1. What advice do you have for that kid whose friends are pulling him or her down?*


  1. What do you like to be called?*


  1. What is your main worry for this school year?*


  1. Which thought most accurately describes you?  *


  1. Who are your best friends?*


  1. Who are your parents, step-parents, or guardians?*


  1. Name some of your favorite songs, tell which singers / rappers you like the best?*


  1. What do you like to do with your friends?*


  1. What foods do you like best? 1 is your favorite and 8 is your least favorite.*
        1 2 3 4 5 6 7 8
    Tacos  
    Pizza  
    Chinese food  
    Spaghetti  
    Vegetarian food  
    Hamburgers  
    Hot Dogs  
    Other  


  1. What are your favorite books?*


  1. What are the three most important qualities in a good friend?*


  1. What are your favorite TV shows?*


  1. Select two of the teenage challenges that you would like more information or help on this year.*
    Being able to see problems from other points of view
    Developing a moral or value system
    Managing more responsibilities as I mature
    Dealing with the physical and mental changes that come with puberty
    Being a better decision maker
    Managing all these intense emotions
    I want healthy, supportive friendships
    Dealing with the changing relationship between myself and my parents


  1. How do you deal with setback / failure?*


  1. It doesn't happen very often, but some days you can get homework in almost every class. Below is a list of homework. Rank it in the order that you would do it. 1 is first. 5 is the last thing you would do.*
        1 2 3 4 5
    30 minutes of daily at home AR reading  
    science  
    social studies  
    math  
    Language Arts / English  


  1. Rank these outcomes for life after high school. 1 is your highest hope. 6 is what you would like to do least.*
        1 2 3 4 5 6
    Attend a university  
    I plan to go to the ALC instead of high school.  
    I will work at a place like Hy Vee, McDonalds, the mall, or Burger King.  
    Attend Minnesota West  
    I would like to go to a 2 year trade school.  
    I want to quit school when I turn 16.  


  1. The following is a list of valuable student skills. 1 is the skill that you think you have the most of. 8 is the skill you are weakest in.*
        1 2 3 4 5 6 7 8
    Being curious to learn knew things  
    Communicating  
    Persisting - not quitting when thnigs are hard  
    Being accurate - doing high quality work  
    Asking questions  
    Controlling your impulses  
    Listening and Listening with understanding  
    Taking responsible risks  


  1. Think of the best teacher you ever had. What made that person a great teacher.*


  1. What are the names and ages of your brothers and sisters?*


  1. What are some of the chores, jobs, and responsibilities you have around your house? Be sure to include child care if you have to do that.*


  1. When you have time all to yourself, what do you like to do?*


  1. What are some of the sport's teams that you follow?*


  1. Which statement best describes you?*
    I think my talents and abilities were pretty much fixed at birth. People are just born smart or dumb.
    If I work hard, practice, and don't quit things I can grow my brain.


  1. Do you have a facebook page?*
    Yes
    No


  1. What kind of grades do you want to get this year?  *


  1. What is the contact information for you and your parents (landline, cell phone #, email)?*


  1. Rank these activities from what you like best to least. 1 is your favorite activity. 8 is your least favorite activity.*
        1 2 3 4 5 6 7 8
    play soccer  
    play volleyball  
    play hacky sack  
    run  
    play baseball  
    ride bike  
    play football  
    play baseball or softball  


  1. What are your favorite movies?*


  1. What are some of the things that teachers do accidentally or on purpose that help give kids negative attitudes about school?*


  1. Why do you come to school?  *


  1. Which best describes your daily time in front of a screen this summer. Screens are TVs, computers, cell phones, tablet computers, IPads, IPods . . . *
    about an hour
    about two hours
    about 3 hours
    about 4 hours
    5 or more hours a day
    I do not have access to any of these things


  1. What kind of career would you like to have when you are all grown up?*


  1. Rank these activities from favorite to least favorite? 1 is your most favorite and 6 is the least favorite*
        1 2 3 4 5 6
    Spend time on the phone  
    Spend time on the computer  
    Spend time playing sports  
    Spend time watching TV  
    Spend time watching movies  
    Other  





Mr. Burns
Worthington Middle School
Worthington, MN