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Student Survey - Grades 5-7
Please pick the best response to each statement below. Please answer honestly - no one at your school will see your
answers.
Name of School: Asian Studies Academy at Bellizzi
How much do you agree or disagree with each of the following statements? When you answer, think
about the way you feel MOST OF THE TIME.
1. Students in this school help each other, even if they are not friends.
Strongly Agree
Agree
Disagree
Strongly Disagree
2. There are lots of chances for students in my school to talk with teachers one​-on-one.
Strongly Agree
Agree
Disagree
Strongly Disagree
Disagree
Strongly Disagree
Disagree
Strongly Disagree
3. At school, other adults besides my teachers know my name.
Strongly Agree
Agree
4. Adults in my community encourage me to take school seriously.
Strongly Agree
Agree
5. Most students in this school talk with their parents about their homework assignments.
Strongly Agree
Agree
Disagree
Strongly Disagree
Agree
Disagree
Strongly Disagree
Disagree
Strongly Disagree
6. My teachers treat me with respect.
Strongly Agree
7. Crime and violence are major concerns at school.
Strongly Agree
Agree
How much do you agree or disagree with each of the following statements? When you answer, think
about the way you are most of the time.
8. I ask for help from my teachers or others when I need it.
Strongly Agree
Agree
Disagree
Strongly Disagree
Agree
Disagree
Strongly Disagree
9. I set goals and then work to reach them.
Strongly Agree
10. I can tell when someone is getting angry or upset before they say anything.
Strongly Agree
Asian Studies Academy at Bellizzi
Agree
Disagree
Strongly Disagree
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11. I work on having positive relationships with friends, family members, and others.
Strongly Agree
Agree
Disagree
Strongly Disagree
Agree
Disagree
Strongly Disagree
Agree
Disagree
Strongly Disagree
Disagree
Strongly Disagree
Disagree
Strongly Disagree
Agree
Disagree
Strongly Disagree
Agree
Disagree
Strongly Disagree
12. I would recommend this school to another student.
Strongly Agree
13. I care about school.
Strongly Agree
14. Adults at this school have high expectations of me.
Strongly Agree
Agree
15. At school, there is an adult who will miss me when I am absent.
Strongly Agree
Agree
16. Students in this school are often teased or picked on.
Strongly Agree
17. Bullies at this school make me feel unsafe.
Strongly Agree
18. School rules are applied equally to all students (regardless of student differences).
Strongly Agree
Agree
Disagree
Strongly Disagree
Disagree
Strongly Disagree
19. The principal does what is best for students.
Strongly Agree
Agree
20. This school provides instructional materials (e.g. textbooks, handouts) that reflect my cultural background, ethnicity, or
identity.
Strongly Agree
Agree
Disagree
Strongly Disagree
Agree
Disagree
Strongly Disagree
Agree
Disagree
Strongly Disagree
21. Parents often attend school events.
Strongly Agree
22. Gangs at this school scare me.
Strongly Agree
Asian Studies Academy at Bellizzi
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23. This school provides effective confidential support and referral services for students needing help because of substance
abuse.
Strongly Agree
Agree
Disagree
Strongly Disagree
In the past 6 months, how many times have you personally known students to do these things?
24. Be under the influence of marijuana
0 Times
1-2 Times
3-6 Times
7-12 Times
12 or More Times
Don't Know
1-2 Times
3-6 Times
7-12 Times
12 or More Times
Don't Know
25. Get into fights
0 Times
26. Be involved in a harrassment or bullying situation
0 Times
1-2 Times
3-6 Times
7-12 Times
12 or More Times
Don't Know
1-2 Times
3-6 Times
7-12 Times
12 or More Times
Don't Know
27. Carry weapons
0 Times
How much do you agree or disagree with each of the following statements? When you answer, think
about the way you feel MOST OF THE TIME.
28. Adults in my community care about what happens in this school.
Strongly Agree
Agree
Disagree
Strongly Disagree
Disagree
Strongly Disagree
29. The students in this school don't really care about each other.
Strongly Agree
Agree
30. If students hear about a threat to school or student safety, they would report it to someone of authority.
Strongly Agree
Agree
Disagree
Strongly Disagree
Disagree
Strongly Disagree
Disagree
Strongly Disagree
31. At this school, students and teachers get along really well.
Strongly Agree
Agree
32. I conduct myself responsibly on social media.
Strongly Agree
Background Information
33. Do you live in Hartford?
Yes
No
Asian Studies Academy at Bellizzi
Agree
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34. What grade are you in?
5
6
7
35. What gender do you identify with?
Male
Female
Transgender
Other
36. How often are you absent?
Always
Sometimes
Never
37. How often do you speak English at home?
Always
Sometimes
Never
38. Which group describes you best?
American Indian
or Alaska Native
Asian
Black/African
American
Hispanic/Latino
Native
Hawaiian/Other
Pacific Islander
White
Other
Multiple
39. Name one way this school could improve.
40. Do you have any questions or comments?
41. Did you feel comfortable taking this survey?
Strongly Agree
Asian Studies Academy at Bellizzi
Agree
Disagree
Strongly Disagree
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Student Survey - Grades 5-7
Please pick the best response to each statement below. Please answer honestly - no one at your school will see your
answers.
Name of School: Asian Studies Academy at Bellizzi
How much do you agree or disagree with each of the following statements? When you answer, think
about the way you feel MOST OF THE TIME.
1. There is an adult at this school whom I feel comfortable talking to about things that are bothering me.
Strongly Agree
Agree
Disagree
Strongly Disagree
Agree
Disagree
Strongly Disagree
Disagree
Strongly Disagree
2. I know how to make friends.
Strongly Agree
3. When students see another student being picked on, they try to stop it.
Strongly Agree
Agree
4. Most students in this school talk with their parents about what they are studying in class.
Strongly Agree
Agree
Disagree
Strongly Disagree
Agree
Disagree
Strongly Disagree
Agree
Disagree
Strongly Disagree
5. This school is badly affected by crime and violence in the community.
Strongly Agree
6. My teachers are fair.
Strongly Agree
How much do you agree or disagree with each of the following statements? When you answer, think
about the way you are most of the time.
7. If someone asks me I can tell them how I am feeling.
Strongly Agree
Agree
Disagree
Strongly Disagree
Disagree
Strongly Disagree
Disagree
Strongly Disagree
Disagree
Strongly Disagree
8. I can control myself when I am frustrated or disappointed.
Strongly Agree
Agree
9. I care about other people's feelings and what they think.
Strongly Agree
Agree
10. I know how to disagree without starting a fight or an argument.
Strongly Agree
Asian Studies Academy at Bellizzi
Agree
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11. I have been the target of hurtful communications through social media.
Strongly Agree
Agree
Disagree
Strongly Disagree
Agree
Disagree
Strongly Disagree
Agree
Disagree
Strongly Disagree
Disagree
Strongly Disagree
1 or 2
3 or 4
5 or more
Agree
Disagree
Strongly Disagree
Disagree
Strongly Disagree
Agree
Disagree
Strongly Disagree
Agree
Disagree
Strongly Disagree
Disagree
Strongly Disagree
12. I have participated in hurtful communications through social media.
Strongly Agree
13. I enjoy coming to this school.
Strongly Agree
14. The adults at this school believe that all students can succeed.
Strongly Agree
Agree
15. I can name ____ adults who really care about me.
0
16. I respect people even if they are different.
Strongly Agree
17. This school shows respect for all students' cultural beliefs and practices.
Strongly Agree
Agree
18. There are consequences if I don't follow the rules at my school.
Strongly Agree
19. I feel safe at my school.
Strongly Agree
20. In this school, students are given a chance to help make decisions.
Strongly Agree
Agree
21. If someone or something is bothering me, I can think of positive ways to deal with the situation.
Strongly Agree
Agree
Disagree
Strongly Disagree
22. After high school, I plan to:
Attend college
Learn a trade
Get a job
Join the military
Other
23. I regularly participate in extracurricular activities in and outside of school, such as sports, clubs, or church.
Strongly Agree
Asian Studies Academy at Bellizzi
Agree
Disagree
Strongly Disagree
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In the past 6 months, how many times have you personally known students to do these things?
24. Steal things
0 Times
1-2 Times
3-6 Times
7-12 Times
12 or More Times
Don't Know
3-6 Times
7-12 Times
12 or More Times
Don't Know
3-6 Times
7-12 Times
12 or More Times
Don't Know
25. Be under the influence of alcohol (beer/wine/liquor)
0 Times
1-2 Times
26. Destroy things (vandalism)
0 Times
1-2 Times
How much do you agree or disagree with each of the following statements? When you answer, think
about the way you feel MOST OF THE TIME.
27. This school is a welcoming place for families like mine.
Strongly Agree
Agree
Disagree
Strongly Disagree
Agree
Disagree
Strongly Disagree
Disagree
Strongly Disagree
Disagree
Strongly Disagree
28. I feel safe going to and from this school.
Strongly Agree
29. I sometimes stay home because I don't feel safe at this school.
Strongly Agree
Agree
30. Students here treat each other with respect.
Strongly Agree
Agree
31. During a typical day, how much time do you spend on social media (Facebook, Twitter, Snapchat, etc.)?
Less than 30 minutes
Between 30 minutes and 1
hour
Between 1 and 1.5 hours
Between 1.5 and 2 hours
More than 2 hours
Background Information
32. Do you live in Hartford?
Yes
No
33. What grade are you in?
5
6
7
34. What gender do you identify with?
Male
Asian Studies Academy at Bellizzi
Female
Transgender
Other
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35. How often are you absent?
Always
Sometimes
Never
36. How often do you speak English at home?
Always
Sometimes
Never
37. Which group describes you best?
American Indian
or Alaska Native
Asian
Black/African
American
Hispanic/Latino
Native
Hawaiian/Other
Pacific Islander
White
Other
Multiple
38. Name one way this school could improve.
39. Do you have any questions or comments?
40. Did you feel comfortable taking this survey?
Strongly Agree
Asian Studies Academy at Bellizzi
Agree
Disagree
Strongly Disagree