Request use of the Staff and Student Surveys

Please complete the information below so that we may create your survey. Once your survey is created, we will send your link, and then you can send it to your staff and/or students. If using the SPBD, we encourage you to send the survey to all staff, both certified and classified, who work directly with students.

You will receive your survey link via email within 1 day. If you fail to receive this link, please check your junk or spam folders.

Which type of survey would you like to create?

Please provide your contact information. We will contact you using this information to provide your school's unique survey link and send you a report once the survey closes. You may exercise your right to be forgotten or request a copy of your data at any time by contacting us.

First Name

Last Name

Email Address

Please provide information about your school. If you have multiple schools, please fill out separate request forms for each school. Please do not use special characters (e.g., numbers, punctuation) in the name of your school. Also, note that your school name will be the title of your data report.

Country

State or Province

School District

School

School Level

Other School Level

Staff Perceptions of Behavior & Discipline (SPBD) Desired Survey Close Date

Please note that you can change this date using the link that will be sent to you (as the survey requestor) via email.

Student Perceptions of Behavior & Discipline Desired Survey Close Date

Please note that you can change this date using the link that will be sent to you (as the survey requestor) via email.

Staff Information

Tell us how many staff work with students in your school. Precise numbers are best for determining response rates; however, if you do not have access to them, please provide your best estimate.

Certificated staff (e.g., teachers, counselors, school psychologists

Classified staff who work directly with students (e.g., paraeducators, librarians, playground supervisors):

Student Information

Tell us how many students attend your school. Precise numbers are best for determining response rates; however, if you do not have access to them, please provide your best estimate.

Schoolwide Expectations

What is the name for your schoolwide expectations?

Be sure to list the language that students would be most likely to recognize. For example, Seaside Middle School's mascot is the Dolphins. They refer to their schoolwide behavioral expectations as The Dolphins Way. Questions about schoolwide expectations in their student survey will appear as follows:

What are The Dolphins Way expectations?

Someone taught me The Dolphins Way expectations.

The Dolphins Way expectations are posted in my classroom.

Acknowledgement System

What is the name for your acknowledgement system?

This refers to the agreed-upon schoolwide acknowledgement or reward system that is part of schoolwide positive behavior supports, such as "Bronco Bucks," "Pride Tickets," or "Gold Stars".

Questions about the acknowledgement system will include the verbatim text entered here. For example, "I like getting acknowledged with Bronco Bucks."

How many years has your school been implementing SWPBS?")

To what degree is your school implementing schoolwide positive behavior supports (SWPBS)?

If you have Schoolwide Evaluation Tool (SET) Benchmarks of Quality (BofQ), or Tiered Fidelity Inventory (TFI) scores within the past 12 months, please record them here.

Date of SET assessment:

SET Total & Domain Scores

A. Expectations Defined: ( /4)

B. Behavioral Expectations Taught: ( /10)

C. On-going System for Rewarding Behavioral Expectations: ( /6)

D. System for Responding to Behavioral Violations: ( /8)

E. Monitoring & Decision-making: ( /8)

F. Management: ( /16)

G. District-Level Support ( /4)

Total / Mean

Date of BofQ assessment:

PBIS Team: ( /6)

Faculty Commitment: ( /6)

Effective Procedures for Dealing with Discipline: ( /11)

Data Entry & Analysis Plan Established: ( /8)

Expectations & Rules Developed: ( /11)

Reward/Recognition Program Established: ( /16)

Lesson Plans for Reaching Expectations/Rules: ( /9)

Implementation Plan: ( /13)

Classroom Systems: ( /14)

Evaluation: ( /13)

Benchmarks Score: ( /107)

Tiered Fidelity Inventory

Date Completed

Please enter the result percentage for each Tiered Fidelity Inventory tier:

Tier 1

Teams

Implementation

Evaluation

Tier 2

Teams

Implementation

Evaluation

Tier 3

Teams

Implementation

Evaluation

Other data or information related to level of implementation:

How do you intend to use the information you receive from your survey?

Do you anticipate or are you experiencing staff related challenges in implementation? If so, please explain.

I acknowledge that data gathered by my school may be used to validate the technical properties of the SPBD / StPBD and used to study its application in schools. I undertand that the identity of my school district and school will not be revealed in this process. Additionally I authorize spbdsupport.com to send me emails at the address entered on this form to facilitate my use of the survey.