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. What are your favorite TV shows?*


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


  1. Who are your best friends?*


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


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


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


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


  1. What do you like to be called?*


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


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


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


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


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


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


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


  1. Who are some of your heroes?*


  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. What are your favorite movies?*


  1. Why do you come to school?  *


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


  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 is your main worry for this school year?*


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


  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  


  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. Which thought most accurately describes you?  *


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


  1. What are your favorite books?*





Mr. Burns
Worthington Middle School
Worthington, MN