HS Connectedness Survey 2016-17

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* 4. Do you participate in any of the following?

Community based-club, group or sport

Employment

School based-club, group or sport

Volunteer experiences

None

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* 5. Do you feel that you have friends in High School?

Yes

If no, what would help you make friends:

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* 6. Do you worry about any of these items?

	Never	Sometimes	Often
Being teased or ridiculed by peers	Being teased or ridiculed by peers Never	Being teased or ridiculed by peers Sometimes	Being teased or ridiculed by peers Often
Being liked by my teachers	Being liked by my teachers Never	Being liked by my teachers Sometimes	Being liked by my teachers Often
Disappointing my family	Disappointing my family Never	Disappointing my family Sometimes	Disappointing my family Often
Doing well on a sports team	Doing well on a sports team Never	Doing well on a sports team Sometimes	Doing well on a sports team Often
Family problems	Family problems Never	Family problems Sometimes	Family problems Often
Getting good grades	Getting good grades Never	Getting good grades Sometimes	Getting good grades Often
Having friends	Having friends Never	Having friends Sometimes	Having friends Often
Having personal items taken from school	Having personal items taken from school Never	Having personal items taken from school Sometimes	Having personal items taken from school Often
Making poor choices to fit in	Making poor choices to fit in Never	Making poor choices to fit in Sometimes	Making poor choices to fit in Often
My health	My health Never	My health Sometimes	My health Often
My appearance	My appearance Never	My appearance Sometimes	My appearance Often
My weight	My weight Never	My weight Sometimes	My weight Often
Taking tests	Taking tests Never	Taking tests Sometimes	Taking tests Often
Time management	Time management Never	Time management Sometimes	Time management Often
Your friends using drugs or alcohol	Your friends using drugs or alcohol Never	Your friends using drugs or alcohol Sometimes	Your friends using drugs or alcohol Often
Your family using drugs or alcohol	Your family using drugs or alcohol Never	Your family using drugs or alcohol Sometimes	Your family using drugs or alcohol Often
You or your friends participating in self harm	You or your friends participating in self harm Never	You or your friends participating in self harm Sometimes	You or your friends participating in self harm Often

Other (please specify)

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* 7. How many adults at the high school could you talk to about a problem or share good news?

None

One or two

Three or more

If none, how can they get to know you better?

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* 8. Name the adults at the high school you would speak to about a problem or to share good news.

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* 9. Please rate how you feel about the following statements:

	Disagree	Not sure	Agree
At least one adult at my school cares about me	At least one adult at my school cares about me Disagree	At least one adult at my school cares about me Not sure	At least one adult at my school cares about me Agree
There is a high school adult who believes that I will be successful	There is a high school adult who believes that I will be successful Disagree	There is a high school adult who believes that I will be successful Not sure	There is a high school adult who believes that I will be successful Agree
I care about my school	I care about my school Disagree	I care about my school Not sure	I care about my school Agree
I feel like I belong at my school	I feel like I belong at my school Disagree	I feel like I belong at my school Not sure	I feel like I belong at my school Agree
I feel safe at my school	I feel safe at my school Disagree	I feel safe at my school Not sure	I feel safe at my school Agree
I feel my parents care about me	I feel my parents care about me Disagree	I feel my parents care about me Not sure	I feel my parents care about me Agree
I feel safe at home	I feel safe at home Disagree	I feel safe at home Not sure	I feel safe at home Agree
I feel safe in my community	I feel safe in my community Disagree	I feel safe in my community Not sure	I feel safe in my community Agree

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* 10. Do you, or any of your friends, engage in any of the following: (check all that apply)

Distracted driving

Drinking alcohol

Self harm behaviors

Sexual intercourse

Smoking Marijuana

Smoking Tobacco cigarettes/cigars

Using Prescription drugs to get high

Using Other illegal drugs to get high

Use Social media to deliberately hurt someone else

Vaping

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* 11. Why do you think you, or your friends, participate in those activities listed above:

Curiosity/boredom

Feel pressure to do so

Fun or excitement

To reduce stress or escape from an uncomfortable situation

To fit in socially

Other (please specify)

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* 12. Choose three of the following problems or issues (listed below), that you feel are most common among HFL high school students.

Academic pressure

Athletic pressure

Cheating

Disrespect for rules or authority

Harassment/bullying

Homophobia

Inappropriate social media use

Substance use/abuse

Racism

Other (please specify)

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* 13. If you are concerned for yourself or a friend, please confidentially list the name(s) and reason. A counselor will reach out to offer support without ever mentioning your name.

HS Connectedness Survey 2016-17

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* 1. First Name and Last Name

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* 2. Grade

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* 3. GENDER

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* 4. Do you participate in any of the following?

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* 5. Do you feel that you have friends in High School?

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* 6. Do you worry about any of these items?

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* 7. How many adults at the high school could you talk to about a problem or share good news?

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* 8. Name the adults at the high school you would speak to about a problem or to share good news.

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* 9. Please rate how you feel about the following statements:

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* 10. Do you, or any of your friends, engage in any of the following: (check all that apply)

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* 11. Why do you think you, or your friends, participate in those activities listed above:

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* 12. Choose three of the following problems or issues (listed below), that you feel are most common among HFL high school students.

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* 13. If you are concerned for yourself or a friend, please confidentially list the name(s) and reason. A counselor will reach out to offer support without ever mentioning your name.

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* 14. We value your input, if you could make one change that would positively impact the students at HFL, what would it be?