CRU INSTITUTE Bel Red Road Suite Bellevue WA Peer by Prettyclear

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									                         CRU INSTITUTE
                  2661 Bel-Red Road, Suite 200
                      Bellevue, WA 98008
                        1-800-922-1988




                 Peer Mediation Program

Evaluation Forms: For Secondary Schools




We wish to thank the Memphis City Schools Center for Safe and Drug Free
Schools for their considerable efforts in helping to develop this research tool.
                    Instructions for Using
                   Peer Mediation Program
          Evaluation Forms: For Secondary Schools
When to Administer the Questionnaires:
Before you begin to train your Peer Mediators, the following forms should be
filled out:

             Administration (BEFORE) Form
             Peer Mediator (BEFORE) Form


After your Peer Mediation training is completed, preferably at the end of the
school year, the following forms should be filled out:

             Administration (AFTER) Form
             Peer Mediator (AFTER) Form
             Mediation Program Coordinator Form

In subsequent years, before you begin Peer Mediation training, each new
Peer Mediator should fill out:

             Peer Mediator (BEFORE) Form


In subsequent years, at the end of the school year, the following forms should
be filled out:

             Administration (AFTER) Form
             Peer Mediator (AFTER) Form
             Mediation Program Coordinator Form

Some questions may not be appropriate: CRU has created these
forms to fit the needs of most schools. However, some of the questions or, in
some cases, some of the questionnaires may not fit your school’s needs. You
should adjust the questionnaires accordingly.

Please return the test results to CRU: CRU is extremely interested in
evaluating its program. If at all possible, please return the results of your
research to CRU. We will, in turn, provide you with feedback of the results from
other schools using these research tools.
                             CRU INSTITUTE
                           Program Evaluation
                                     ADMINISTRATION
           (This form should be filled out BEFORE Conflict Manager Training)


    Today’s Date_______________

    Your Name__________________________________________________

    Name of your school ___________________________________________

    Position______________________________________________________




    1. Please rate the following conditions at your school (circle one)

Safety                   excellent      very good   good       fair         poor

Positive
Communication            excellent      very good   good       fair         poor

Morale                   excellent      very good   good       fair         poor

Suspensions             very high       high        moderate   moderately   low
                                                               low
In-Class
Attendance               very high      high        moderate   moderately   low
                                                               low
Violence                 very high      high        moderate   moderately   low
                                                               low




    2. How many disciplinary referrals were there:

            in the previous semester:          ____________
      in the previous school year:           ____________


3. How many suspensions were there:

      in the previous semester:       ____________

      in the previous school year:           ____________


4. How many expulsions were there:

      in the previous semester:       ____________

      in the previous school year:           ____________


5. Number of written teacher disciplinary referrals:

      in the previous semester:       ____________

      in the previous school year:           ____________


6. How many fights occurred:

      in the previous semester:       ____________

      in the previous school year:           ____________


7. How many calls to police were made:

      in the previous semester:       ____________

      in the previous school year:           ____________




     This document is based upon a research questionnaire developed by
      the Memphis City Schools Center for Safe and Drug Free Schools
                              CRU INSTITUTE
                             Program Evaluation
                              PEER MEDIATOR
      (This form should be used BEFORE and IMMEDIATELY AFTER
                         Peer Mediation Training)

Today’s Date_______________

Your Name (optional)_______________________________________

Your mother’s name_________________Your birth month_______________

Name of your school _______________________________________

Grade___________            Male:_____________
                            Female:____________

1. Generally, how do you resolve conflict? (circle one)

With Family         talk it out   argue        leave         do nothing   fight

With Friends        talk it out   argue        leave         do nothing       fight

In Sports           leave         do nothing   talk it out   argue        fight

With Strangers      leave         do nothing   talk it out   argue        fight


2. How do you rate yourself in the following areas? (circle one)

                                                  Excellent                   Poor
      Your school attendance                          1     2        3    4      5
      Arriving to classes on time                      1     2       3    4           5
      Your self-esteem                                 1     2       3    4           5
      The way you get along with your parents          1     2       3    4           5
      The way you get along with your friends          1     2       3    4           5
      Your grades                                      1     2       3    4           5
      Your attitude in the classroom                   1     2       3    4           5
      Your self-control                                1     2       3    4           5
     3. How do you rate yourself in the following areas? (circle one)

My ability to
communicate
with others             excellent    very good    good        fair          poor

My ability to help
solve conflicts         excellent    very good    good        fair          poor

My listening skills     excellent    very good    good        fair          poor

My sensitivity to
students whose
backgrounds are
different from mine     excellent    very good    good        fair          poor

My knowledge of
conflict resolution
strategies              excellent    very good    good        fair          poor




     4. Please rate the following conditions at your school. (circle one)

Safety                  excellent    very good    good        fair          poor

The way people
talk to each other      excellent    very good    good        fair          poor

School spirit           excellent    very good    good        fair          poor

Violence                low          moderately   moderate     very high    high
                                     low




           This document is based upon a research questionnaire developed by
            he Memphis City Schools Center for Safe and Drug Free Schools

								
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