[Sample directions for participants: Thank you for your willingness to participate in a study regarding your learning experiences on campus. The information you provide will be kept confidential and will not be associated with you personally at any time. The responses gathered from this study will be used to improve learning experiences at this institution. Your time and input are valuable!]
PART I:
- Circle the number that indicates the extent to which you agree/disagree with each of the following statements about your views or perspectives in general.
Strongly Disagree / Disagree / Neutral / Agree / Strongly Agree
- I am willing to work hard in a course to learn the material even if it won’t lead to a higher grade.
- When I do well on a test, it is usually because I am well-prepared, not because the test is easy.
- I frequently do more reading in a class than is required simply because it interests me.
- I frequently talk to faculty outside of class about ideas presented during class.
- Getting the best grades I can is very important to me.
- I enjoy the challenge of learning complicated new material.
- My academic experiences (i.e., courses, labs, studying, discussions with faculty) will be the most important part of college.
- My academic experiences (i.e., courses, labs, studying, discussions with faculty) will be the most enjoyable part of college.
Source: Wabash National Study 2006-2008,
- For each statement listed below, circle the number that indicates the extent to which you feel it is characteristic of you. For example, if the statement is not at all like you, circle number 1 under “Extremely Uncharacteristic,” or if you really can’t decide if the statement is or is not characteristic of you, circle number 3 under “Uncertain.”
Extremely Uncharacteristic / Somewhat Uncharacteristic / Uncertain / Somewhat Characteristic / Extremely Characteristic
- I would prefer complex to simple problems.
- I like to have the responsibility of handling a situation that requires a lot of thinking.
- Thinking is not my idea of fun.
- I would rather do something that requires little thought than something that is sure to challenge my thinking abilities.
- I try to anticipate and avoid situations where there is likely a chance I will have to think in depth about something.
- I find satisfaction in deliberating hard and for long hours.
- I only think as hard as I have to.
- I prefer to think about small, daily projects to long-term ones.
- I like tasks that require little thought once I’ve learned them.
- The idea of relying on thought to make my way to the top appeals to me.
- I really enjoy a task that involves coming up with new solutions to problems.
- Learning new ways to think doesn’t excite me very much.
- I prefer my life to be filled with puzzles that I must solve.
- The notion of thinking abstractly is appealing to me.
- I would prefer a task that is intellectual, difficult, and important to one that is somewhat important but does not require much thought.
- I feel relief rather than satisfaction after completing a task that required a lot of mental effort.
- It’s enough for me that something gets the job done; I don’t care how or why it works.
- I usually end up deliberating about issues even when they do not affect me personally.
Source: Wabash National Study 2006-2008,
- During the current school year, how much has your coursework emphasized the following:
Very often / Often / Sometimes / Never
- Analyzing the basic elements of an idea, experience, or theory, such as examining a particular case or situation in depth and considering its components
- Synthesizing and organizing ideas, information, or experiences into new, more complex interpretations and relationships
- Making judgments about the value of information, arguments, or methods, such as examining how others gathered and interpreted data and assessing the soundness of their conclusions
- Applying facts, theories, or methods to practical problems or new situations
Source: National Survey of Student Engagement, “Deep Learning Scale”,
- During the current school year, about how often have you done the following:
Very often / Often / Sometimes / Never
- Worked on paper or project that required integrating ideas or information from various sources
- Included diverse perspectives (i.e. those arising from different races, religions, genders, political beliefs) in class discussions or writing assignments
- Put together ideas or concepts from different courses when completing assignments or during class discussions
- Discussed ideas from your readings or classes with faculty members outside of class
- Discussed ideas from your readings or classes with others outside of class (students, family members, co-workers, etc.)
- Examined the strengths and weaknesses of your own views about a topic or issue
- Tried to better understand someone else's views by imagining how an issue looks from his or her perspective
- Learned something that changed the way you understand an issue or concept
Source: National Survey of Student Engagement, “Deep Learning Scale”,
PART II: The following questions pertain to your actions outside of class and how you are feeling.
5. Please indicate how much each of the following are sources of stress in your life:
None / Very Little / Some / Quite a Bit / Very Much
a. / School work / ○ / ○ / ○ / ○ / ○
b. / Extracurricular activities / ○ / ○ / ○ / ○ / ○
c. / Social life and friends / ○ / ○ / ○ / ○ / ○
d. / Dating / ○ / ○ / ○ / ○ / ○
e. / Sex / ○ / ○ / ○ / ○ / ○
f. / Financial pressures / ○ / ○ / ○ / ○ / ○
g. / Family issues / ○ / ○ / ○ / ○ / ○
h. / Concerns about college / ○ / ○ / ○ / ○ / ○
Source: Developed for BTtoP NSSE consortium questions (2007), adapted from CORE survey
6. Please list below other sources of stress in your life.
______
______
______
7. Please answer the following questions are about how you have been feeling during the [insert time frame: past month, past two weeks]. Place a check mark in the box that best represents how often you have experienced or felt the following:
Please answer the following questions are about how you have been feeling during the [insert time frame: past month, past two weeks]. Place a check mark in the box that best represents how often you have experienced or felt the following: / Never
(0) / Once or Twice (1) / About once a week
(2) / 2 or 3 times a week
(3) / Almost every day
(4) / Every day
(5)
- happy
- interested in life
- satisfied
- that you had something important to contribute to society
- that you belonged to a community (i.e. a social group, your neighborhood, your city)
- that our society is becoming a better place for people
- that people are basically good
- that the way our society works makes sense to you
- that you liked most parts of your personality
- good at managing the responsibilities of your daily life
- that you had warm and trusting relationships with others
- that you had experiences that challenge you to grow and become a better person
- confident to think or express your own ideas or opinions
- that your life has a sense of direction or meaning to it
Source: Keyes, Corey. 2009. Atlanta. Brief Description of Mental Health Continuum Short Form (MHC-SF).
PART III: We would like to learn more about your views regarding yourself, your campus and community life.
8. Thinking about your involvement at your high school, how well do the following statements characterize you?
Not at all / Very Little / Somewhat / Quite a bit / Very much
a. / I read our school newspaper regularly (electronic or print). / ○ / ○ / ○ / ○ / ○
b. / I often discussedschool issues with my friends. / ○ / ○ / ○ / ○ / ○
c. / I was active in issues affecting my school. / ○ / ○ / ○ / ○ / ○
d. / I believed I could have an impact at my school. / ○ / ○ / ○ / ○ / ○
Source: Developed for BTtoP NSSE consortium (2007)
9. What would you say best described your motivation to be involved at your high school?
○ / Nothing, I was not motivated to participate at my high school
○ / It is my duty/responsibility
○ / I felt I could make a difference
○ / My campus helped me, so I wanted to give back
○ / To enhance my leadership skills
○ / I was encouraged to get involved by my family/friends
Source: Montclair State University, developed by Bringing Theory to Practice project team
10. Thinking about your involvement in the local community (the community where you live), how well do the following statements characterize you?
Not at all / Very little / Somewhat / Quite a bit / Very much
a. / I follow the local news (via TV, newspaper, Internet, other) to keep informed on local issues. / ○ / ○ / ○ / ○ / ○
b. / I often discuss local community issues with my friends. / ○ / ○ / ○ / ○ / ○
c. / I am active in the local community. / ○ / ○ / ○ / ○ / ○
d. / I believe I can have an impact on solving problems in the local community. / ○ / ○ / ○ / ○ / ○
Source: Developed for BTtoP NSSE consortium questions (2007), adapted from CORE survey
11. What would you say best described your motivation to be involved in your local community?
○ / Nothing, I was not motivated to participate in the local community
○ / It is my duty/responsibility
○ / I feel I can make a difference
○ / My community helps me, so I want to give back
○ / To enhance my leadership skills
○ / I was encouraged to get involved by my family/friends
Source: Montclair State University, developed by Bringing Theory to Practice project team
12. Thinking about your involvement at the national level (in the United States), how well do the following statements characterize you?
Not at all / Very Little / Somewhat / Quite a bit / Very much
a. / I read national newspapers regularly. / ○ / ○ / ○ / ○ / ○
b. / I often discuss national issues with friends. / ○ / ○ / ○ / ○ / ○
c. / I am active in events nationally / ○ / ○ / ○ / ○ / ○
d. / I believe that I can have an impact on solving problems at the national level. / ○ / ○ / ○ / ○ / ○
Source: BTtoP NSSE consortium questions (2007)
13.What would you say best described your motivation to be involved at a national level?
○ / Nothing, I was not motivated to participate at the national level
○ / It is my duty/responsibility
○ / I feel I can make a difference
○ / My nation helps me, so I want to give back
○ / To enhance my leadership skills
○ / I was encouraged to get involved by my family/friends
Source: Montclair State University, developed by Bringing Theory to Practice project team
14. During the past year, indicate how often you engaged in the following:
Never / Sometimes / Occasionally / Often / Very Often
a. / Attended religious services. / ○ / ○ / ○ / ○ / ○
b. / Participated in organized demonstrations. / ○ / ○ / ○ / ○ / ○
c. / Performed volunteer work. / ○ / ○ / ○ / ○ / ○
d. / Voted in a student election. / ○ / ○ / ○ / ○ / ○
e. / Performed community-service as a part of class or for a graduation requirement. / ○ / ○ / ○ / ○ / ○
f. / Discussed religion. / ○ / ○ / ○ / ○ / ○
g. / Discussed politics with friends. / ○ / ○ / ○ / ○ / ○
h. / Discussed politics with family. / ○ / ○ / ○ / ○ / ○
i. / Discussed politics in class. / ○ / ○ / ○ / ○ / ○
j. / Performed community-service as part of an organization or group. / ○ / ○ / ○ / ○ / ○
Source: Montclair State University, developed by Bringing Theory to Practice project team
15. Please indicate your level of agreement with the following items:
Strongly disagree / Disagree somewhat / Neither Agree nor Disagree / Agree somewhat / Strongly agree
a. / Adults should give time for the good of their community. / ○ / ○ / ○ / ○ / ○
b. / Social problems are not my concern. / ○ / ○ / ○ / ○ / ○
c. / People who receive social services have only themselves to blame for needing such services. / ○ / ○ / ○ / ○ / ○
d. / Social problems are more difficult to solve than I used to think. / ○ / ○ / ○ / ○ / ○
e. / If I could change one thing about society, it would be to achieve a greater sense of social justice. / ○ / ○ / ○ / ○ / ○
f. / The most important community service is to help individuals. / ○ / ○ / ○ / ○ / ○
g. / For the most part, individuals control whether they are wealthy or poor. / ○ / ○ / ○ / ○ / ○
h. / I feel I can have an impact on solving the problem in my community. / ○ / ○ / ○ / ○ / ○
i. / It is important to me to volunteer my time to help people in need. / ○ / ○ / ○ / ○ / ○
j. / I feel uncomfortable working with people who are different than me in things such as race, wealth and life experience. / ○ / ○ / ○ / ○ / ○
Source: Eyler, J., & Giles, D. (1999). Where's the learning in service-learning?. San Francisco: Jossey-Bass.
16. Please rate your ability compared to your peers on the following items:
Much worse than most / Not as good as most / About the same / Better than most / Much better than most
a. / Respecting the views of others / ○ / ○ / ○ / ○ / ○ / ○
b. / Ability to listen / ○ / ○ / ○ / ○ / ○ / ○
c. / Ability to compromise / ○ / ○ / ○ / ○ / ○ / ○
d. / Being effective in accomplishing goals / ○ / ○ / ○ / ○ / ○ / ○
e. / Thinking about the future / ○ / ○ / ○ / ○ / ○ / ○
f. / Ability to work with others / ○ / ○ / ○ / ○ / ○ / ○
g. / Thinking about others before myself / ○ / ○ / ○ / ○ / ○ / ○
Source: Eyler, J., & Giles, D. (1999). Where's the learning in service-learning?. San Francisco: Jossey-Bass.
N19 / Part IV
17.Have you ever consumed alcohol, taken illegal drugs, or used prescription medication (your own or others) for a purpose not prescribed?
○ / Yes: IF YES, PLEASE CONTINUE TO COMPLETE THE REST OF THE SURVEY
○ / No: IF NO, STOP HERE – Thank you for your participation!
______
18. / Approximately how many DRINKS do you consume in an AVERAGE WEEK?
Number of drinks per week: ______
19. / Approximately how many DRINKS do you consume in an AVERAGE MONTH?
Number of drinks per month: ______
20. / Approximately how many TIMES PER WEEK do you drink? (If you drink less often than once per week, put zero). Number of times per week: ______
21. / Approximately how many TIMES do you drink PER MONTH? (If you drink less often than once per month, put zero). Number of times per month: ______
22. / When you drink, how many drinks would you estimate you consume in an average sitting?(please give a specific number) ______
23. / Generally speaking, when you drink, would you say you are most likely to:
○ / Only have one or two drinks / ○ / Drink until you feel drunk
○ / Drink until you have a “buzz” / ○ / None of the above
Source (Q18-Q23): Developed for BTtoP NSSE Consortium (2007)
24. / The following is a list of reasons people sometimes give for drinking alcohol. Thinking of all the times you drink, how often would you say that you drink for each of the following reasons.
Never / Some of the time / Half of the time / Most of the time / Always
a. / To forget your worries / ○ / ○ / ○ / ○ / ○
b. / Because your friends pressure you to drink / ○ / ○ / ○ / ○ / ○
c. / Because it helps you enjoy a party / ○ / ○ / ○ / ○ / ○
d. / Because it helps you when you feel depressed or nervous / ○ / ○ / ○ / ○ / ○
e. / To be sociable / ○ / ○ / ○ / ○ / ○
f. / To cheer up when you are in a bad mood / ○ / ○ / ○ / ○ / ○
g. / Because you like the feeling / ○ / ○ / ○ / ○ / ○
h. / So that others won’t kid you about not drinking / ○ / ○ / ○ / ○ / ○
i. / Because it’s exciting / ○ / ○ / ○ / ○ / ○
j. / To get high / ○ / ○ / ○ / ○ / ○
k. / Because it makes social gatherings more fun / ○ / ○ / ○ / ○ / ○
l. / To fit in with a group you like / ○ / ○ / ○ / ○ / ○
m. / Because it gives you a pleasant feeling / ○ / ○ / ○ / ○ / ○
n. / Because it improves parties and celebrations / ○ / ○ / ○ / ○ / ○
o. / Because you feel more confident and sure about yourself / ○ / ○ / ○ / ○ / ○
p. / To celebrate a special occasion with friends / ○ / ○ / ○ / ○ / ○
q. / To forget about your problems / ○ / ○ / ○ / ○ / ○
r. / Because it’s fun / ○ / ○ / ○ / ○ / ○
s. / To be liked / ○ / ○ / ○ / ○ / ○
t. / So you won’t feel left out / ○ / ○ / ○ / ○ / ○
Source: Cooper, ML. 1994. “Motivations for Alcohol Use among Adolescents: Development and Validation of a Four Factor Model.” Psychological Assessment. 6:117-128.
25. During your most recent school year, how often have you experienced the following due to your drinking or drug use?
Never / Once / Twice / 3-5 times / 6-9 times / 10 or more
a. / Performed poorly on a test or important project / ○ / ○ / ○ / ○ / ○ / ○
b. / Missed school / ○ / ○ / ○ / ○ / ○ / ○
c. / Had a hangover / ○ / ○ / ○ / ○ / ○ / ○
d. / Got nauseated or vomited / ○ / ○ / ○ / ○ / ○ / ○
e. / Had memory loss/ blacked out / ○ / ○ / ○ / ○ / ○ / ○
f. / Did something you regretted later on / ○ / ○ / ○ / ○ / ○ / ○
g. / Got into an argument or fight / ○ / ○ / ○ / ○ / ○ / ○
h. / Damaged property / ○ / ○ / ○ / ○ / ○ / ○
i. / Had sex when I ordinarily would not / ○ / ○ / ○ / ○ / ○ / ○
j. / Been hurt or injured / ○ / ○ / ○ / ○ / ○ / ○
k. / Got into trouble with my parents or other authorities / ○ / ○ / ○ / ○ / ○ / ○
Source: College Alcohol Problems Scale-R (CAPS-r),
26. / How often have you used marijuana?
○ / Used in the past week
○ / Used in the past 30 days
○ / Used at another point during the most recent academic year
○ / Used prior to the current academic year
○ / Never used
27. / How often have you used other drugs?
○ / Used in the past week
○ / Used in the past 30 days
○ / Used at another point during the most recent academic year
○ / Used prior to the current academic year
○ / Never used
28. / How often have you used prescription drugs for recreation (purposes other than those for which they were prescribed)?
○ / Used in the past week
○ / Used in the past 30 days
○ / Used at another point during the most recent academic year
○ / Used prior to the current academic year
○ / Never used
Source (Q26-Q28): Developed for BTtoP NSSE Consortium (2007)
Thank you for your participation in this important research!