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  1. Surveys
  2. 2013
  3. August
  4. S
  5. SEL Asset Inventory
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Exit Survey
 
 
What is your name?
   
 
 
 
What is your current grade level?
   
 
 
 
What is today's date?
   
 
 
Support:

For each item below, select whether the statement is true:
not at all/rarely, somewhat/sometimes, very/often, or extremely/almost always.
Not at all or rarely Somewhat or sometimes Very or often Extremely or almost always
I feel loved and supported at home.
I feel comfortable asking my parents for advice and help when I have a problem.
There are adults besides my parents who care about me and support me when I need help.
My neighbors care about me.
My teachers and classmates care about me and encourage me.
My parents are actively involved in helping me to succeed in school.
 
 
Empowerment:

For each item below, select whether the statement is true:
not at all/rarely, somewhat/sometimes, very/often, or extremely/almost always.
Not at all or rarely Somewhat or sometimes Very or often Extremely or almost always
I feel valued and appreciated by the adults in my community.
I am included in the decisions made at home and in my community.
I have opportunities to help others in my community.
I feel safe at home, at school, and in my neighborhood.
 
 
Boundaries and Expectations:

For each item below, select whether the statement is true:
not at all/rarely, somewhat/sometimes, very/often, or extremely/almost always.
Not at all or rarely Somewhat or sometimes Very or often Extremely or almost always
My family has clear and consistent rules and consequences for misbehavior.
My family always knows where I am.
My school has clear rules and consequences for misbehavior.
My neighbors talk to my family if I misbehave.
The adults in my family model positive, responsible behavior.
My closest friends demonstrate positive, responsible behavior.
My parents and teachers expect me to do my best at school and in other activities.
 
 
Constructive Use of Time:

For each item below, select whether the statement is true:
not at all/rarely, somewhat/sometimes, very/often, or extremely/almost always.
Not at all or rarely Somewhat or sometimes Very or often Extremely or almost always
I participate in music, art, drama, or creative writing two or more times per week.
I participate in after-school activities or community programs (lessons, practice, clubs, etc.) two ore more times per week.
I attend religious programs or services one or more times per week.
I spend time on most days doing things at home besides watching TV or playing video games.
I spend time on most days interacting with my family.
 
 
Commitment to Learning:

For each item below, select whether the statement is true:
not at all/rarely, somewhat/sometimes, very/often, or extremely/almost always.
Not at all or rarely Somewhat or sometimes Very or often Extremely or almost always
I am motivated and work hard to do well in school.
I am actively engaged in learning at school.
I enjoy participating in learning activities outside of school.
I usually hand in my homework on time.
I care about my teachers.
I care about other staff and adults at school.
I read for fun most days of the week.
 
 
Positive Values:

For each item below, select whether the statement is true:
not at all/rarely, somewhat/sometimes, very/often, or extremely/almost always.
Not at all or rarely Somewhat or sometimes Very or often Extremely or almost always
I believe that it is important to help other people.
I believe it is important to speak up for equal rights for all people.
I believe it is important to stand up for your beliefs.
I believe it is important to tell the truth.
I believe it is important to accept personal responsibility for behavior.
I believe it is important to have a healthy lifestyle.
 
 
Social Competencies:

For each item below, select whether the statement is true:
not at all/rarely, somewhat/sometimes, very/often, or extremely/almost always.
Not at all or rarely Somewhat or sometimes Very or often Extremely or almost always
I think carefully before making a decision.
I'm usually happy about the results of my decisions.
I care about other people's feelings.
I enjoy making friends.
I try to calm myself when I am frustrated or angry.
I am comfortable with people of different racial, ethnic, and cultural backgrounds.
I am comfortable with my own cultural identity.
I can avoid people who are likely to get me into trouble.
I am able to say no to doing wrong or dangerous things.
I try to resolve conflicts peacefully.
 
 
Positive Identity:

For each item below, select whether the statement is true:
not at all/rarely, somewhat/sometimes, very/often, or extremely/almost always.
Not at all or rarely Somewhat or sometimes Very or often Extremely or almost always
I feel that I have influence over the things that happen in my life.
I like the person that I am.
I am proud of myself.
I think about my purpose in life.
I am optimistic and positive about my future.