Chapter & Year: ___________________
Survey ID: ________
EnvironMentors Program Survey Dear Students, This four-page survey is designed to help us at EnvironMentors get to know you better, as well as to help us improve the program. It will take 10-15 minutes to complete and your participation is voluntary. Your answers are completely anonymous and will be held in strict confidentiality. If you agree to take the survey, we will ask you to take it again in April. You may withdraw your consent and decide not to take this survey at any time. Thank you! Survey Identifier: Please complete this section so that we can keep track of your responses while keeping them anonymous. In the space below, please write the two-digit DAY of your th birthday. For example, if your birthday is on March 4 , you th would write 04. If your birthday is on January 26 , you would write 26.
In the space below, please write the last two letters of your LAST NAME. For example, if your last name is Jackson, you would write ON. If your last name is Gonzalez, you would write EZ.
Part I: Nature and Environmental Awareness Please rate the following statements based on how you feel TODAY by circling the appropriate number. Strongly Disagree
Somewhat Disagree
Neutral
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Strongly Agree
1) I enjoy going to places where I am surrounded by nature.
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2) I enjoy being in places with lots of trees and plants.
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3) Spending time in nature helps me feel healthy.
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4) I feel safe when I am in nature.
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5) I would like to learn more about nature.
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6) I am aware of environmental issues facing my community.
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7) I am aware of environmental issues facing the earth.
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8) I am concerned about environmental issues facing my community.
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9) I am concerned about environmental issues facing the Earth.
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10) I believe it’s important to do things that protect the environment.
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TURN THE PAGE FOR PART II 1
Part II: College Please rate the following statements based on how you feel TODAY by circling the appropriate number.
11) I am interested in going to college. 12) I would like to attend college to study about the environment. 13) I am familiar with how to apply to college. 14) I believe I could succeed in college. 15) I am interested in studying technology in college. 16) I am interested in studying science in college. 17) I am interested in studying engineering in college.
Strongly Disagree
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18) If you are interested in going to college, list up to 3 colleges or universities you are interested in attending: a)________________________________________________________________________________________________ b)________________________________________________________________________________________________ c)________________________________________________________________________________________________
19) If you are interested in going to college, list up to 3 subjects you are interested in studying: a)________________________________________________________________________________________________ b)________________________________________________________________________________________________ c)________________________________________________________________________________________________
TURN THE PAGE FOR PART III
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Part III. Career 20) List up to 3 jobs you are interested in pursuing in your future career: a)________________________________________________________________________________________________ b)________________________________________________________________________________________________ c)________________________________________________________________________________________________
Please rate the following statements based on how you feel TODAY by circling the appropriate number.
21) I am interested in a job that involves working with the environment. 22) A job that involves science is of interest to me. 23) I am interested in a job that involves technology. 24) A job that involves engineering is of interest to me.
Strongly Disagree
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Part IV. Scientific Research Please rate the following statements based on how you feel TODAY by circling the appropriate number.
25) Scientific research is something I am capable of doing. 26) I like doing scientific research. 27) I have the skills to do a science research project. 28) I would like to learn more about science. 29) I would like to learn more about technology.
Strongly Disagree
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TURN THE PAGE FOR PART V 3
Part V: Demographic Information 30) What is your age? _____
31) What is your gender? (circle one)
Female
32) What is your year in school? (circle one)
Male
Freshman
Sophomore
Junior
Senior
33) Which of the following best describes your race or ethnicity? (circle all that apply) African-American
Asian
Caucasian
Latino/Hispanic
Native American
Other ________________
34) Have you ever participated in EnvironMentors before now? _____ Yes ______ No
35) Which EnvironMentors chapter are you in? (write in the college/university) ________________________________
36) What is the name of your high school? __________________________________
END OF SURVEY
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