Civic Responsibility Survey

Civic Responsibility Survey
Furco‚ Muller‚ & Ammon‚ 1998
Elementary School Version
Please say whether you disagree or agree with each sentence. Circle the number that best matches your answer.
1. I feel like I am a part of the community.
2. I pay attention to news events that affect the community.
3. Doing something that helps others is important to me.
4. I like to help other people‚ even if it is hard work.
5. I know what I can do to help make the community a better place.
6. Helping other people is something everyone should do‚ including me.
7. I know a lot of people in the community‚ and they know me.
8. I feel like I can make a difference in the community.
9. I try to think of ways to help other people.
10. Everyone should pay attention to the news‚ including myself.
Middle School Version
Please indicate how strongly you disagree or agree with each statement. Circle the number that best describes your response .
1. I feel like I am a part of the community.
2. I pay attention to news events that affect the community.
3. Doing something that helps others is important to me.
4. I like to help other people‚ even if it is hard work.
5. I know what I can do to help make the community a better place.
6. Helping other people is something everyone should do‚ including me.
7. I know a lot of people in the community‚ and they know me.
8. I feel like I can make a difference in the community.
9. I try to think of ways to help other people.
10. Everyone should pay attention to the news‚ including myself.
High School Version
Please indicate how strongly you disagree or agree with each statement. Circle the number that best describes your response.
1. I have a strong and personal attachment to a particular community.
2. I often discuss and think about how political‚ social‚ local or national issues affect the community.
3. I participate in political or social causes in order to improve the community.
4. It is my responsibility to help improve the community.
5. I benefit emotionally from contributing to the community‚ even if it is hard and challenging work.
6. I am aware of the important needs in the community.
7. I feel a personal obligation to contribute in some way to the community.
8. I am aware of what can be done to meet the important needs in the community.
9. Providing service to the community is something I prefer to let others do.
10. I have a lot of personal contact with people in the community.
11. Helping other people is something that I am personally responsible for.
12. I feel I have the power to make a difference in the community.
13. I often try to act on solutions that address political‚ social‚ local or national problems in the community.
14. It is easy for me to put aside my self interest in favor of a greater good.
15. I participate in activities that help to improve the community‚ even if I am new to them.
16. I try to encourage others to participate in the community.
17. Becoming involved in political or social issues is a good way to improve the community.
18. I believe that I can make a difference in the community.
19. I believe that I can have enough influence to impact community decisions.
20. I am or plan to become actively involved in issues that positively affect the community.
21. Being concerned about state and local issues is an important responsibility for everybody.
22. Being actively involved in community issues is everyone’s responsibility‚ including mine.
23. I try to find time or a way to make a positive difference in the community.
24. I understand how political and social policies or issues affect members in the community.
  • community
This instrument can be found on page 140-144 of Assessing Outcomes in Child and Youth Programs: A Practical Handbook‚ available online at: http://fyi.uwex.edu/topic/youth/
Responses are scored for the 3-point Likert scale format:
1= Disagree‚ 2= Agree a little and 3= Agree a lot Elementary School.
The 6 point Likert scale 1 = Strongly disagree‚ 2=Disagree‚ 3=Slightly disagree‚ 4= Slightlyagree‚ 5=Agree and 6= Strongly agree for middle and High school
Permission: Not needed to use this scale‚ however it is copyrighted by the authors who request that the following citation be given if you use the scale.

Furco‚ A.‚ Muller‚ P. & Ammon M.S. (1998) The Civic Responsibility Survey. Service-Learning Research Center‚ University of California‚ Berkley.