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Dear Student,
Thank you for taking this survey of your school.
Please be honest, your answers are anonymous.
Read each item carefully and make your best judgment - depending on YOUR experience.

If you have questions ask the supervisor or teacher for help.
My school is:
Piney Grove Elementary
Cash Elementary
Caleb's Creek Elementary
Jefferson Elementary
Sherwood Forest Elementary
Vienna Elementary
Whitaker Elementary
Walkertown Elementary
Union Cross Elementary
Southwest Elementary
Speas Elementary
Ibraham Elementary
Old Richmond Elementary
Ward Elementary
Meadowlark Elementary
Clemmons Elementary
Lewisville Elementary
Sedge Garden Elementary
Kimmel Farm Elementary
Moore Elementary
Rural Hall Elementary
Bolton Elementary
Mineral Springs Elementary
Kernersville Elementary
Petree Elementary
Cook Elementary
Downtown Elementary
Brunson Elementary
Forest Park Elementary
Morgan Elementary
My grade in school is
My ethnicity is
African American
Native American
Asian or Pacific Islander
For each item below, you will have 5 selection options. If you think the best answer is between two of the descriptions select the middle option.

Again all responses are completely anonymous - no one will be made aware of your responses.

If you have questions ask the supervisor or teacher for help
1. Most of the students at this school
Don’t keep the school pretty and clean even when teachers tell us to.
Keep the school clean because we would get in trouble if we did not.
Help the teachers and other kids make the school clean and nice to look at.
2. When I am at school, I feel like
No one cares about me at this school.
I am part of a good school, but not really a family.
The teachers, classmates, and I are like a family.
3. At this school
A lot of students don’t get along.
Students who are alike or friends get along.
Students all get along no matter what they look like or where they are from.
4. The popular students at this school
Think they are better and are often mean to others.
Are nice to the other popular students.
Are nice to the other students.
5. At this school, I feel safe
Some days and not other days.
Only in my classroom.
Everywhere in the school.
6. In my class, the rules
Are not clear and the kids are afraid of doing something to make the teacher angry.
Are clear and keep the kids from misbehaving.
Are clear and help the class be a great place to be.
7. At this school when a student uses mean language
Usually nothing happens to them, so they keep doing it.
Sometimes they get in trouble from an adult.
Other students point out to them that it is not right.
8. At this school
I do not feel like I can be honest with the adults at the school.
There are one or two adults that I can trust to talk to, but not many.
I trust and can talk to most of the adults.
9. On the playground
There are only adults to supervise.
We have peer mediators and/or “Peacemakers,” but they mostly just get kids in trouble.
We have peer mediators and/or “Peacemakers” that help the students solve their own problems.
10. The best way to describe how I feel about this school is
This school is okay, but I would rather be at another school.
I like this school.
I am very proud to be a student here.
ASSC School Climate Instrument SCAI-E-S v3.1
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