SD survey

 

 

Name:  Class Period: 
Year in School:  Number of years with access to IEP:

In how many mainstream classes do you participate?  

Rate the following items on a scale of 1-6, with a score of 1 being the most true, 6 being the least true:  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

2

 3

 4

 5

 6

 1. I feel that I am not given very many choices or options.  

2.  My emotions are often caused by the actions of someone else.  

3.  I am supposed to behave in the way other people want me to. 

4. I am not always able to be who I really want to be. 

5.  My actions are the result of being told what to do, even if I don't see the point. 

6.  When I experience success, I feel as though it was thanks to someone else. 

7.  I feel forced to do things I don’t want to do. 

8.  When I look in the mirror, I feel like the person I see can’t really be me. 

9.  I rarely feel a sense of accomplishment in what I do. 

10.  I behave in a way that will get me out of doing something I see as pointless. 

11.  My emotions, actions, and behaviors influence very few people. 

12.  I can control the decisions of my superiors if I behave in a way that makes them uncomfortable.