1 

## Baseline 12 **th**



## -**grade Student Survey**
INSTRUCTIONS This survey asks about your involvement in school and the community, learning and study habits, and plans for the future. The survey should take about 35 minutes. Your answers are very important to us and will not be shared with anyone in your school, family, or community. This is not a test. There are no right or wrong answers. You may skip any question you do not wish to a nswer. If you have a question about the survey, raise your hand and someone will help you.
SECTION A: BACKGROUND 1. What school do you go to? School name 2. How many years have you been in the Roads to Success program? 0 1 2 or more 3. Do you plan to graduate this year? 1 Yes 0 No 4. What grades do you typically get in school? 1 Mostly As 2 As and Bs 3 Mostly Bs 4 Bs and Cs 5 Mostly Cs 6 Cs and Ds 7 Mostly Ds 8 Ds and Fs 9 Mostly Fs 5. Please indicate whether you agree or disagree with the following statements: a . There is no point in deciding on a job when the future is so uncertain. b . I can’t seem to become very concerned about my future occupation. c . I seldom think about the job that I want to enter. d . I’m not going to worry about choosing an occupation until I am out of school. e . As far as choosing an occupation is concerned, something will come along sooner or later. f . I really can’t find any work that has much appeal to me. 6. Different people have different strength s . No one is good at everything, and each of us emphasizes some strengths more than others. Please rate how strongly you have developed each of the following abilities using the scale below : 1 (Not strong) to 5 (Strongest) a . Keeping upbeat b. Making decis ions by myself c. Taking responsibility for my actions d. Sticking up for my beliefs e. Counting on myself f. Doing what’s right for me. SECTION B: POSTSECONDARY PLANNING 7 . Do you plan to apply to or register at any colleges (including 2 year, 4 year, and technical/ trade) this year? Please include any colleges you have already submitted applications to or registered at. I f yes, please answer questions 8

- 11 . If no, please go to question 1 2

. 1 Yes 0 No2

8 . How many 2

-year schools do you plan to apply to or register at? 1 0 2 1 3 2

-4 4 More than 4 List names of schools : ________ 9 . How many 4

-year schools do you plan to apply to or register at? 1 0 2 1 3 2

-4 4 More than 4 List names of schools : ________ 10 . How many tech/trade schools do you plan to ap ply to or register at? 1 0 2 1 3 2

-4 4 More than 4 List names of schools : ________
11 . Have you been accepted to any schools? If so, how many? 1 2

-year schools ___ 2 4

-year schools ____ 3 Tech/trade schools ____ List names of schools : _____ 12 . Do you have an up

-to

- date resume? 1 Yes 0 No 13 . What are your main plans for after school? Are you: 1 Going to college (Go to Section C) 2 Starting a full

-time job (Go to Section D) 3 Starting a part

-time job (Go to Section D) 4 Joining the military (Go to Section D) 5 Other (for example, travel, volunteer, or mission) (Go to Section E) 6 No current plans (Go to Section E) SECTION C: COLLEGE PLANS AFTER HIGH SCHOOL If you are planning to attend college starting in the Fall of next year, please answer the fo llowing questions.
14 . What type of college do you plan to attend? 1 2

-year college 2 4

-year college or university 3 Technical or trade school List name of school: 15 . Where will you prefer to live? 1 in campus housing (dorm) 2 in off campus housing (apartment) 3 at home 16 a. Do you know what you will major in? If no, skip the next two questions. 16 b. If yes, what is your planned major? 1 Yes 0 No Planned major (survey

- assisted): _______ 1 6c . How interested are you in this major? 1 (not very) 2 3 4 5 (very)
1 7 . How much do you expect to college to cost? Please provide your best guess. 1 Tuition and Fees ___________ 2 Room & Board ____________ 3 Books & Supplies __________ 4 Misc. ____________________3

1 8 . Have you or your parents filled out the Free Application for Federal Student Aid (FAFSA)? 1 Yes 0 No 1 9 . Have you received offers of financial aid? If no, skip the next question. 1 Yes 0 No 20 . What amount of financial aid have you been offered? 1 Loans ________ 2 Scholarships _________ 3 Grants

___________ 4 Work Study ________ 21 . Do you plan to work while you are in school? If yes, got to SECTION D. If no , please go to SECTION E. 1 Yes 2 No 3 Not sure SECTION D: WORK PLANS AFTER HIGH SCHOOL If you are planning to start a full

-time or part

-time job next Summer or Fall, please fill out the items below.
22 . Do you have a current job? If so, please list the job title. If yes, go to the next question. If no, go to question 24. 1 Yes 0 No Job tit le (survey

- assisted): _______ 2 3 . Is this job: Part

-time ( How many hours?: ___) Full

-time 2 4 . Do you plan to work in this job after high school? If yes, go to the next question. Otherwise, skip the next question. 1 Yes 0 No
2 5 . Do you plan to work in this job: Part

-time (How many hours?: ___) Full

-time Freelance 2 6 . Have you applied for [a job/other] jobs for after you complete high school? If so, please list the job title(s). 1 Yes 0 No Job title (survey

- assisted): _______ 27 . Have you received a job offer for work after you complete high school? If so, please list the job title(s). 1 Yes 0 No Job title (survey

- assisted): _______ 28 . Do you plan to apply for a job for after you complete high school? If yes, please go to th e next question. Otherwise, skip the next question. 1 Yes 0 No

29 . Do you know what job(s) you plan to apply for? If yes, please list the job title(s). 1 Yes 0 No Job title (survey

- assisted): _______ [For those not planning to go to college after high school {i.e., skipping from section B to D}:] 30. Do you plan to take postsecondary classes while working? 1 Yes 0 No

SECTION E: FUTURE PLANS 31 a. Do you have an interest in a specific career? If no, skip the next two questions. 31b. If yes, what career? _______ 1 Yes 0 No List career (survey

- assisted)4

31c . How interested are you in this career? 1 (not very) 2 3 4 5 (very)
32 . How far in school do you think you will get? 1 Some high school 2 GED 3 High school graduate 4 Technical or trade school 5 Associates degree (2 year college degree) 6 Bachelor’s degree (4 year college degree) 7 Master’s degree or equivalent 8 Ph.D., MD or other advanced degree (like a medical or law degree) 9 Other (Please d escribe) _________ d Don’t know
33. What is the job or occupation you expect or plan to have at age 30? _______ Job / occupation name (survey

- assisted) 0 I don’t know

34. How much education do you think you need to get the job or occupation you expect o r plan to have at age 30? 1 Some high school 2 GED 3 High school graduate 4 Technical or trade school 5 Associates degree (2 year college degree) 6 Bachelor’s degree (4 year college degree) 7 Master’s degree or equivalent 8 Ph.D., MD or other advanced degree (like a medical or law degree) 9 Other (Please describe) _________ d Don’t know
SECTION F: DEMOGRAPHICS 35 . When were you born? (Month / Day / Year) 36 . Are you: 1 Male? 2 Female? 37 . How do you describe yourself? 1 American Indian or Alaskan Native 2 Asian 3 Black or African

-American 4 Hispanic or Latino/Latina 5 Native Hawaiian or Other Pacific Islander 6 White 7 Other (Please describe) ___________ Mark all that apply5

38 . What is the highest level of education completed by your mother or female guardian? 1 Some high school 2 GED 3 High school graduate 4 Technical or trade school 5 Associates degree (2 year college degree) 6 Bachelor’s degree (4 year college degree) 7 Master’s degree or equivalent 8 Ph.D., MD or other advanced degree (like a medical or law degree) 9 Other (Please describe) _________ d Don’t know

39 . What is the highest level of education completed by your father or male guardian? 1 Some high school 2 GED 3 High school graduate 4 Technical or trade school 5 Associates degree (2 year college degree) 6 Bachelor’s degree (4 year college degree) 7 Master’s degree or equivalent 8 Ph.D., MD or other advanced degree (like a medical or law degree) 9 Other (Please describe) _________ d Don’t know

40 . What is the main language spoken at home? 1 English 2 Spanish 3 English and Spanish equally 4 Other (Please describe) _________ 41 . Do you or your parents have a ny of the following at home ? Check all that apply 1 Air conditioner/air conditioning 2 Car 3 Computer 4 DVD player 5 Multiple cell phones 6 Motorcycle 7 Your own room 8 Multiple televisions 9 A washing machine 42 . Do you have any siblings or anyone else in your home who currently attends college? 1 Yes 0 No

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 1830

- NEW. The time required t o complete this information collection is estimated to average 35 minutes per respondent, including the time to review instructions, gather the data needed, and complete and review the inform ation collected. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, DC 20202. If you have comments or concerns regarding the status of your individual subm ission of this form, write directly to: U.S . Department of Education, Office of Career, Technical, and Adult Education, 400 Maryland Avenue, SW, Washington, DC 20202

- 7100.