Student Questionnaire – Course 3

Your Name:
Email Address:
School: Fleecefield
Course: Mindful Mentor
Class: Year 5

Rate yourself from 1-4 about the following topics by selecting the appropriate number:

1 = Poor, 2 = Ok, 3 = Good, 4 = Excellent

1. I feel confident in my abilities – I am a confident person who does well at school and at home.
1234
2. I am good at working in a group. I have good teamwork skills and I work well with others.
1234
3. I am a leader. Other people look to me for answers and I am able to help others with confidence.
1234
4. I have good relationships with my classmates. I get on well with most people and I know I am well liked. I find it easy to talk and play with other people.
1234
5. I feel like I really belong to the school community. I feel connected to others and I have a sense of purpose. I know I am valuable.
1234
6. I feel positive about the future. I know I have the skills to move forward after Primary School and do well.
1234
7. I feel happy going to school – I enjoy being at school and I know what to do or who to ask for help with any problems or issues that may happen during the school day.
1234
8. I feel happy when I am at home with my family. I am able to work through any problems or issues (either by myself or with family members) that arise when I’m at home.
1234
9. Whenever I am anxious or worried, I understand how I can make myself feel better or less stressed.
1234

Please add any further comments or feedback about your Success club sessions this term:

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