"Reinforcement Survey Template (Any Age Level)"

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Reinforcement Survey
(Any age level)
Name: ___________________________________
Date: _______________________
The best reward the teacher could give you for good work is:
What would you change if you could?
If you could choose two students in the class to do an activity with, who would you choose?
What do you like to do on weekends?
What are the special jobs you like to help the teacher with the most?
What makes you a best friend to others?
What motivates you to do well in class?
Have you ever memorized anything?
If you had $100.00 to spend on anything in a store, what would you buy?
What kind of compliments do you get from others?
If you could change one class rule for one hour, what would it be?
Do you like to try to figure out problems?
What would your preferred seating arrangement in class be?
Reinforcement Survey
(Any age level)
Name: ___________________________________
Date: _______________________
The best reward the teacher could give you for good work is:
What would you change if you could?
If you could choose two students in the class to do an activity with, who would you choose?
What do you like to do on weekends?
What are the special jobs you like to help the teacher with the most?
What makes you a best friend to others?
What motivates you to do well in class?
Have you ever memorized anything?
If you had $100.00 to spend on anything in a store, what would you buy?
What kind of compliments do you get from others?
If you could change one class rule for one hour, what would it be?
Do you like to try to figure out problems?
What would your preferred seating arrangement in class be?
I feel my homework is:
My parents think homework is:
Homework creates different problems at home. They are:
What instructional equipment do you like to use the most in class?
If a book was written about you, what would the title be?
The person in this school you would like most to praise you when you do good work is:
What was the nicest thing anyone ever did for you?
Have you ever laughed so hard that it was difficult to stop? What happened?
Where do you like to sit in class?
What is a good teacher?
What activities do you wish we would do more in class?
Do you like your parents to ask you what you did in class?
If you had 10 minutes of free time during class, what would you most like to do?
What makes a “best friend”?
What is your preferred way to learn new information?
When do you feel proudest of yourself in class?
Name 3 things you would wish for:
1.
2.
3.
I would rather be (number 1-5)
_____ alone
_____ with family members
_____ with older friends
_____ with friends my age
_____ with younger friends
Name a teacher who has made school a happier place for you.
Some teacher behaviors that “set me off” are:
1.
2.
3.
4.
5.
Teachers that I am most comfortable with do these behaviors:
1.
2.
3.
4.
5.
It is important that these people understand my good times and bad times:
1.
2.
3.
My early childhood was :
confusing
divorce-related
happy
fun
stressful
___________
If I could change one thing about my childhood, it would be:
I don’t mind if my friends dress strange, but when others dress strange I feel:
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