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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


Hilldale Public Schools313 E Peak Blvd.Muskogee, OK  74403


This institution is an equal opportunity provider.

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