1

Baseline 11th-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 answer. 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. 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

4. 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.

5. Different people have different strengths. 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 decisions 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

6. Do you know what math course (if any) you will take 

in your senior year? If yes, please list the course name.

1 Yes

0 No

Name of course (or no course): _______ 

7. Do you know what science course (if any) you will take 

in your senior year? If yes, please list the course name.

1 Yes

0 No

Name of course (or no course): _______ 

8. Do you plan to take a foreign language course in your 

senior year? If yes, please list the language and year.

1 Yes

0 No

Name of course: _______ 
2

9. Have you visited a college, university, or other 

postsecondary school? If yes, how many? If no, skip the 

next question.

1 Yes

0 No

Number visited: _______ 

10. What kind of school(s) have you visited? Please check 

all that apply.

1 Community college or 2-year school ___

2 4-year college or university ____

3 Technical or trade school ____

11. Have you taken or registered for a workforce test 

such as the ACT WorkKeys, Armed Services Vocational 

Aptitude Battery (ASVAB), or the Test of Adult Basic 

Education (TABE)? Please check all that apply.

1 Yes, ACT WorkKeys

2 Yes, ASVAB

3 Yes, TABE

4 Yes, Other (please name): _______

5 No

12. Have you participated in any of the following? Please 

check all that apply

1 Job shadowing

2 Job or career fair

3 Internship

4 Apprenticeship

5 School-based business or enterprise

13. Do you have an up-to-date resume? 1 Yes

0 No

14. 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 No current plans (Go to Section E)

SECTION C: COLLEGE PLANS AFTER HIGH SCHOOL

If you are planning to attend college after high school, please answer the following questions. 

15. 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: 

16. Where will you prefer to live? 1 in campus housing (dorm)

2 in off campus housing (apartment)

3 at home

17a. Do you have a major you are interested in?

If no, skip the next two questions. 

17b. If yes, what is that major?

1 Yes

0 No

Planned major (survey-assisted): _______

17c. How interested are you in this major? 1 (not very)

2

3

4

5 (very)

18. 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. ____________________

19. 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
3

SECTION D: WORK PLANS AFTER HIGH SCHOOL

If you are planning to work after high school, please fill out the items below.

20. 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 25.

1 Yes

0 No

Job title (survey-assisted): _______

21. Is this job: Part-time (How many hours?: ___)

Full-time

22. 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

23. Do you plan to work in this job: Part-time (How many hours?: ___)

Full-time

Freelance

24. Do you plan to apply for a job for after you complete 

high school? 

If yes, please go to the next question. Otherwise, skip the 

next question.

1 Yes

0 No

25. 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): _______

SECTION E: FUTURE PLANS AND ATTITUDES

26a. Do you have an interest in a specific career?

If no, skip the next two questions.

26b. If yes, what career? _______

1 Yes

0 No

List career (survey-assisted)

26c. How interested are you in this career? 1 (not very)

2

3

4

5 (very)

27. 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 describe) _________

d Don’t know

28. 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
4

29. How much education do you think you need to get 

the job or occupation you expect or 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

30. When were you born? (Month / Day / Year)

31. Are you: 1 Male?

2 Female?

32. 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 apply

33. 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

34. 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

35. What is the main language spoken at home? 1 English

2 Spanish

3 English and Spanish equally

4 Other (Please describe) _________
5

36. Do you or your parents have any 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

37. 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 to 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 information 

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 submission 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.