Needs Assessment
School for Creative Studies
Homeroom Teacher *
First Name *
Your answer
Last Name *
Your answer
Grade Level *
1. Personal Concerns
Answer each statement and check how true it is.
I need help making and keeping friends. *
Required
I need help dealing with anger. *
Required
I need help with stress or anxiety. *
Required
I need help handling teasing or being bullied. *
Required
2. School Concerns
Answer each statement and check how true it is.
I need help with being more organized & managing my time. *
Required
I need help with study skills. *
Required
3. High School and Career
Answer each statement and check how true it is.
I need help with understanding high school graduation requirements. *
Required
I need help with planning for a career & options after high school. *
Required
I will continue my education after high school. *
Required
4. About You
Answer each statement and check how true it is.
Please list any other concerns or needs that were not mentioned that YOU PERSONALLY would like the Counselor or the school to help you with:
Your answer
I would like to meet with the Counselor once a week for during the next 9 weeks to make sure that my grades are ok *
I am interested in lunchtime yoga to help me relax *
Required
I feel comfortable going to see my counselor to get help. *
Required
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