Academic Motivation Screen (1 page)
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ACADEMIC MOTIVATION SCREEN
Student _______________________________________ Date of screen ________________________
Date of birth __________________________________ Screener ______________________________
When you were doing your schoolwork
this past week, as best you can tell, did you:
1. try your best to finish your schoolwork?
Ne
ve
r
Questions
So
me
of
the
tim
e
Al
ot
of
the
tim
e
Al
l
all or a
the lmo
tim st
e
Circle the number in the column that best describes how you acted and felt about your
schoolwork this past week. Tell whether you felt or acted in the way described never, some
of the time, a lot of the time, or all or almost all the time. Be sure to circle the number that
is under the column heading that fits your answer.
0
1
2
3
2. worry that others would make fun of how
you were doing?
3
2
1
0
4. ask for help when you needed it?
0
1
2
3
3. pay attention?
0
1
2
3
5. care how well you did?
0
1
2
3
7. give up when you got “stuck”?
3
2
1
0
9. keep track of what you completed?
0
1
2
3
6. feel sad because you thought you would
do badly?
8. fight “discouraging” thoughts?
3
0
2
1
1
2
10. plan ahead of time what you needed to do?
0
1
2
12. notice that you were making progress?
0
1
2
11. worry that you were not doing as well as
other students?
13. put off doing your schoolwork?
14. set a goal that you thought you could
accomplish if you tried?
15. figure out a way to be less nervous
while doing the work?
SUBTOTALS
TOTAL SCORE
3
3
0
0
2
2
1
1
0
3
3
1
0
1
0
2
2
3
3
3
_____ + _____ + _____ + _____
_____
From Enhancing Academic Motivation: An Intervention Program for Young Adolescents.
Copyright © 2006 by Norman Brier. Research Press (800-519-2707; www.researchpress.com)
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