Part I--Demographics
 

Directions: Respond to each item by filling in the blank on the computer scan sheet which most accurately describes you.
 

1. Type of School
 

A. elementary school C. high school E. other
 

B. middle school D. vocational/technical
 

2. Total Years at The School
 

A. one C. three E. five

B. two D. four
 

3. Type of Grades I Usually Get
 

A. "A" C. "C" E. "F"

B. "B" D. "D"
 

4. Gender
 

A. female B. male
 
 

Continued. . . . Copyright c 1998

C. R. Bulach

Cbulach@westga.edu
 
 
 
 
 
 
 
 
 
 
 
 

Part II--Survey Items
 

Directions: Use the scale below to respond to each item by filling in the blank on the computer scan sheet for the response which comes closest to describing how often your teachers use the behavior.
 

A B C D E  NEVER SELDOM SOMETIMES OFTEN ALWAYS

 

5. My teachers greet me when I enter the room.

6. My teachers call me by my name.

7. My teachers reward or compliment me for good behavior.

8. My teachers enforce the same rules for all students.

9. My teachers inform my parents about my progress.

10. My teachers recognize me for academic achievement.

11. My teachers recognize me for extra-curricular achievement.

12. My teachers display my work.

13. My teachers eat lunch with me.

14. My teachers provide an orderly classroom.

15. My teachers take a personal interest in what I do outside the classroom.

16. My teachers give me opportunities to make decisions that affect me.

17. My teachers create an environment where I feel safe.

18. My teachers teach me at my ability level.

19. My teachers make time for me before and after school.

(Over)
 
 
 
 

20. My teachers maintain eye contact with me when they talk to me.

21. My teachers ask for my opinion.

22. My teachers return work promptly with comments.

23. My teachers give me help when I don't understand or respond.

24. My teachers use negative criticism with me.

25. My teachers ask me to help with classroom tasks.

26. My teachers are positive with me.

27. My teachers provide "treats" and "goodies" on special occasions.

28. My teachers allow me to have fun at their expense.

29. My teachers use sarcasm with me.

30. My teachers intervene when students pick on each other.