Needs and Safe School Survey
Hilldale Public Schools
Needs Assessment & Safe School Survey
Please answer each question honestly in your own opinion based on your experiences. Thank you for your help. This form is confidential and will only be viewed by the School Counselor.
1. Which most closely describes you?
A. Teacher B. Parent C. School Administrator D. Patron E. Student
2. Your gender is:
A. Female B. Male
3. In your opinion, what is the most important step in creating safer schools? (rank by priority)
___ A. Installing metal detectors and hiring armed security personnel
___ B. Searches of lockers and bookbags, or banning lockers and bookbags altogether
___ C. Instituting policies to require students to wear uniforms
___ D. Legislating tougher gun laws (for ownership and criminal punishment)
___ E. Teaching weapons/gun safety to students
___ F. Teaching relationship education/conflict resolution to students
___ G. Teaching parents how to communicate with their children
___ H. Having a closed campus policy and controlling access to the school grounds
4. What of the following factors do you think is the most responsible for recent school shootings? (Rank in order)
___ A. The availability of guns to minors
___ B. Inadequate security/safety measures in schools
___ C. Parents being less involved in their children=s lives
___ D. Violent TV/Movies/Video Games/Internet
___ E. Peer pressure or influence
___ F. Alcohol or other drugs
___ G. Kids being bullied and/or teased at school
___ H. Other: __________________________________________
5. In your opinion, what most often keeps students from talking to their parents about what’s really going on in their lives?
A. Afraid of getting into trouble
B. Feeling like they will be misunderstood
C. Feeling like it won=t help
D. Don=t know
6. How significantly do you think television/movies contribute to violent youth behavior?
A. Very significantly B. Significantly C. Somewhat significantly D. Not at all
7. How significantly do you think the violent internet/video games contribute to aggressive youth behavior?
A. Very significantly B. Significantly C. Somewhat significantly D. Not at all
8. The most important gift we can give the youth of today is:
A. Time B. Knowledge C. Love D. Material Possessions E. A good education
9. This school tries to make everyone feel included:
A. Always B. Almost Always C. Often D. Sometimes E. Never
10. Adults at this school care that the students do the best schoolwork they can:
A. Always B. Almost Always C. Often D. Sometimes E. Never
11. I feel safe at this school.
A. Always B. Almost Always C. Often D. Sometimes E. Never
Parents Only Section: (All other patrons please skip to # 21)
12. What grade(s) is (are) your child(ren) in: (circle all that apply)
A. Elementary B. Middle School C. High School D. No children in school
13. How many instances of being bullied at school has your child personally experienced within the
last school year?
A. 0 B. 1 or 2 C. 3 - 5 D. 6 - 10 E. 11 - 20 F. > 20
14. How often does your child feel fearful of being attacked or harmed at school?
A. Never B. Very rarely C. Sometimes D. Most of the time
15. Has your family had a discussion about youth violence?
A. Yes B. No
16. In the past week, how many hours has your child spent watching television?
A. 0- 4 hours B. 5- 10 hours C. 11-17 hours D. 18-25 hours E. >25 hours
17. If any of these happened to your child, who did your child tell? (Check all that apply)
A. No one B. A friend C. School staff D. Parent E. Other person
18. Where did it happen? (Check all that apply)
A. Classroom B. Before/After school C. Hallway D. Bathroom E. Locker room
19. Did you report the problem to school staff?
A. Yes B. No
20. Was the problem solved?
A. Yes B. No
Comment Section
Thank you for your comments, which help us plan and improve our intervention programs.
21. What is the most serious problem in our school?
22. How would you improve the school?
23. List any ideas that the school can do to stop the bullying or teasing:
24. Any other comments that you would like to make:
25. Would you be interested in participating in our career fair or speaking to a class?
If so, please leave your name and profession:
E-mail & contact information:
Please return this form to Ms. Fenton, School Counselor. All information will be kept confidential.
You may also contact me personally at 683-0763 or tfenton@hilldaleps.org