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This is a sample survey that could be used with 4th and/or 5th graders. It is highly recommended that you utilize this or some version of it to gather baseline data before rolling out your plans with students (and then annually thereafter in order to track changes).
This link will force a copy so that you can add, remove, or edit questions however fits your district needs. Some options worth considering:
-Adding a name field in order to follow up with individual students regarding their interests in STEM
-Adding a race field in order to better track success with subgroups
-Adding or revising the list of STEM Careers to include ones that you would like to generate more interest in within your 6-12 schools (ie, if you have a CTE Drone program, add "drone pilot")