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* 1. What grade are you in?

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* 2. What are your plans after high school?

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* 3. What after school activities are you or have you been involved in?

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* 4. What are some other after school activities you'd be interested in having at Sexton?

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* 5. Do you feel like your basic needs are being met. Basic needs include food, clothing, shelter, healthcare, etc.

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* 6. Please complete the table by selecting one response per row.

  Yes Sometimes No
It is important to go to school.
I come to school everyday. 
My teachers care about me. 
I like going to school. 
I like my classes. 
I have friends at school. 
I think it's important to do well in school. 
I get good grades in all of my classes.
My family cares that I come to school. 
My family cares that I do well in school. 
My parent/guardian helps me with my schoolwork. 
I have sibling(s) that dropped out of high school. 
I feel safe at school. 
I experience a lot of bullying at school. 
My parents want to be involved at Sexton. 

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* 7. What are some incentives for you to come to school everyday? Select all that apply.

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* 8. Please complete the table below by checking one response per row.

  Already have this  Need this  Don't need Unsure
Tutoring programs 
Help with getting clothing
Help with getting school supplies
Help with getting food
Help with getting water
Shelter/housing support for you or your family 
Health/Medical support
Programs that teach about college and how to go to college 
Programs to help you with job skills and getting a job
Programs that provide students a chance to give back to peers and the community
Arts programs 
Confidence building programs
After school programs and activities
Help with transportation 
Programs that encourage your parents to get involved at Sexton 
Help preventing teen pregnancy
Sex education programs
Mental health support 
Rewards for increased attendance
Anti-bullying programs 
Anti-Cyber bullying programs
Programs that allow students to develop a one-on-one relationship with an adult

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* 9. Do you feel you have at least one adult in your life that cares about you?

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* 10. What are some barriers that prevent you or your peers from succeeding in school or coming to school? Select all that apply.

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* 11. Check the areas the CIS team can help you, and list your name in the comment box if you want us to contact you.

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* 12. Do you know what Communities In Schools does at Sexton?

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* 13. Have you benefited from the resources or programs from Communities In Schools (clothing, school supplies, food, hip hop program, coding program, learning about jobs, volunteering)?

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* 14. Do you have any questions or things you want to share with the team?

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* 15. To enter the raffle to win a basket of fried chicken please list your lunch period and name.

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