Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Student Name
First Name
Last Name
What School Do You Attend
Please Select
Los Amigos Elementary School
Boyd Elementary School
Casey Elementary School
Kelley Elementary School
Morgan Elementary School
Trapp Elementary School
Werner Elementary School
Student Grade
*
Please Select
2nd
3rd
4th
5th
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.
Please answer the following questions to your best ability.
*
Rows
Strongly Agree
Agree
Neither agree or disagree
Disagree
Strongly Disagree
I feel happy and ready to learn at school.
I know how to calm down when I feel upset or mad.
I can talk about my feelings
I treat others with kindness.
I feel good about who I am.
I make good choices even when I feel strong emotions
When someone is being left out, I try to help.
I have at least one adult that I trust and feel comfortable talking to.
I have enjoyed learning boxing skills
I feel like the boxing program has made coming to school exciting.
What is one to two things you are looking forward to learning in the program?
(Leave Blank Until End of Program) What is one to two things you enjoyed learning in this program?
Is there any boxing program teacher that you’d like to share your thoughts about?
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