1. Are you enrolled in the V.A.L.U. sevice learning class?      Yes  No

2. How many hours a month do you do volunteer work in your community?

3. How often have you done volunteer work during the past year?

Not at all   Occasionally      Frequently

4. Since entering middle school, have you performed any community/volunteer service?   

Yes  No

If yes, how was the service performed? (check as many as needed) 

a. as part of a course or class 

b. as part of a school-sponsored activity (example: National Honor Society, school club, school team, etc.).  

c. as a part of a non-school group (example: church, family, etc.).

5. I consider myself a(n)… (check one)

A student

B student

C student

F student

Please select one response for each item below.

1-Never    2-Seldom   3-Often     4-Always

By volunteering in the community I can learn…

1-Never    2-Seldom   3-Often     4-Always

6. More about it.

Select a number 1 2 3 4

7. About different careers.

Select a number 1 2 3 4

8. More about myself.

Select a number 1 2 3 4

9. About people who are different than me.

Select a number 1 2 3 4

10. About other cultures.

Select a number 1 2 3 4

11. More about responsibilities.

Select a number 1 2 3 4

12. More about the working world.

Select a number 1 2 3 4

13. New skills.

Select a number 1 2 3 4

So far, during this school year…    

1-Never    2-Seldom   3-Often     4-Always

14. I had adult responsibilities

Select a number 1 2 3 4

15. I made important decisions

Select a number 1 2 3 4

16. I did things myself instead of observing

Select a number 1 2 3 4

17. I had freedom to develop and use my own ideas

Select a number 1 2 3 4

18. I had freedom to explore my own interests

Select a number 1 2 3 4

19. My ideas were considered

Select a number 1 2 3 4

So far, during this school year…    

1-Never    2-Seldom   3-Often     4-Always

20. I had challenging tasks

Select a number 1 2 3 4

21. I felt I made a contribution

Select a number 1 2 3 4

22. What I did was interesting

Select a number 1 2 3 4

In Floresville…                              

1-Never    2-Seldom   3-Often     4-Always

23. I feel like I am part of a community.

Select a number 1 2 3 4

24. I feel like I can make a difference in the community.

Select a number 1 2 3 4

25. I have a strong attachment to my community.

Select a number 1 2 3 4

Generally…            

1-Never    2-Seldom   3-Often     4-Always

26. I feel that doing something to help others is important to me.

Select a number 1 2 3 4

27. I like to help other people, even if it is hard work.

Select a number 1 2 3 4

28. I know what I can do to help make the community a better place.

Select a number 1 2 3 4

29 I feel I have the power to make a difference in the community.

Select a number 1 2 3 4

30. I believe that I can personally make a difference in the community.

Select a number 1 2 3 4

I believe…                               

 1-Never    2-Seldom   3-Often     4-Always

31. Helping other people is something everyone should do, including myself.

Select a number 1 2 3 4

32. It is my responsibility to help improve the community.

Select a number 1 2 3 4

33. I have a personal resonsibility to contribute in some way to the community.

Select a number 1 2 3 4

34. Helping other people is something I am personally responsible for.

Select a number 1 2 3 4

35. Being actively involved in community issues is everyone's responsibility, including mine.

Select a number 1 2 3 4