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Exit Survey
 
 
Please complete the attached anonymous survey. Your responses will be strictly confidential and can never be linked to you. You may stop at any time. The data you provide will be part of an Intel National Science Talent Search entry. Please answer each question directly and honestly.
Your effort is greatly appreciated.

Thank You!
 
 
 
What grade are you in?
   
 
 
 
How old are you?
   
 
 
 
What is your ethnicity? (check all that apply)
 
White/ Caucasian
 
Spanish/Hispanic/Latino
 
Black/ African American
 
Asian Indian
 
Chinese
 
Filipino
 
Japanese
 
Korean
 
Vietnamese
 
Middle Eastern
 
Other Asian
 
Other
 

 
 
 
Were you born in the United States?
 
Yes
 
No
 
 
 
If not, when did you move to the United States? (Age & Year) ex. 5, 2003
   
 
 
In the past seven days, how many hours did you listen to music of your own choosing each day?
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
 
 
 
For each of the following items, please indicate the degree to which you feel the statement is characteristic, or true, to you.
Strongly Disagree Disagree Agree Strongly Agree
1. The work in my school is hectic
2. All work is appreciated
3. I have to deal with many worried and anxious students
4. I miss my deadlines
5. My school’s environment is encouraging and incites learning
6. My school work leaves no time to contribute to the demands at home
7. I have enough resources that I may access easily
8. I am expected to do more than I’m prepared for
9. I have no time to pursue games or leisure activities with friends
10. I am satisfied with the grades I receive
11. I feel bad when I know I could have put more effort into a task
12. I suffer from low self-esteem
13. We are encouraged to aim higher
 
 
Over the last two weeks, how often have you been bothered by the following problems?
Not at all Several days More than half of the days Nearly every day
1. Excessive anxiety or worry about a number of events or activities?
2. Finding it difficult to control worrying?
3. Feeling restless or on edge?
4. Being easily fatigued?
5. Difficulty concentrating or your mind going blank?
6. Being irritable?
7. Having muscle tension?
8. Having disturbed sleep, such as difficulty falling asleep, difficulty staying asleep or restless unsatisfying sleep?
9. Feeling distressed because of the problems above?
 
 
(In relation to questions 1-9)
Very Difficult Difficult Slightly Difficult I do not have these problems.
10. How difficult have these problems made it for you to do your work?
11. How difficult have these problems made it for you to take care of things at home?
12. How difficult have these problems made it for you to get along with others?
 
 
 
In general, how difficult is it for you to keep up with the workload from your classes?
 
Very Hard
 
Hard
 
Easy
 
Very Easy
 
 
 
Typically, where do you fall within the class average (of your entire grade)?
 
Below
 
Slightly below
 
Average
 
Slightly above
 
Above
 
 
On your last report card, what grade did you receive in: (Only respond to those which apply to you.)
ex. A+, B, or C-
English
Additional English Course
Math
Additional Math Course
Science
Additional Science Course
Social Studies
Additional Social Studies
Foreign Language
Additional Foreign Language Course
 
 
In the last seven days, how long did you work on school assignments at home?
ex. 1 hour 30 minutes
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
 
 
 
In the last 5 school days, what amount of homework did you complete per subject?
All Most Some None I am not in this course.
English
Additional English Course
Math
Additional Math Course
Science
Additional Science Course
Social Studies
Additional Social Studies
Foreign Language
Additional Foreign Language Course
 
 
 
If a teacher assigns work to do in class, I usually complete the task.
 
Rarely
 
Sometimes
 
Most of the time
 
Always
 
 
 
I rarely complete work in class.
 
Strongly disagree
 
Disagree
 
Agree
 
Strongly agree
 
 
In the past week, how many hours/minutes did you study for:
Hours Minutes
an English exam
a math exam
a science exam
a history exam
a foreign language exam