High School Needs Assessment
Your counselor, Mrs. Arney, wants to make sure you have the BEST school year possible! Your opinion is important, so please answer the following questions. Your answers will help me plan workshops, small group, and individual counseling throughout the school year.

IF YOU HAVE AN ISSUE IN NEED OF IMMEDIATE ATTENTION, PLEASE CONTACT MRS. ARNEY.

Note: These responses will be kept confidential (meaning what you say here stays here), except if you want to hurt yourself, hurt someone else, or if requested by court.

First and Last Name *
Your answer
My Grade Level *
The following topics are common issues that high school students may face. For each topic, please select:
Classroom Counseling - I want to talk about this with my whole class. (Ex: scholarship workshop, study skills workshop, etc.)

Small Group - I want to talk about this with a group of 3-4 students who might need help with the same topic.

Talk Privately with Counselor - This is an issue I would like to talk to the counselor about privately.

NONE of the these - This issue does not affect me and I do not need to talk about it.

Please select ONE response for each statement below: *
Classroom Counseling
Small Group
Talk Privately with Counselor
NONE of these
Questions about college/careers
Learn about scholarships and how to apply
Feeling better about myself (gaining self-confidence)
Coping with teasing/bullying
How to stand up bullying
Illness or death of loved one/friend
Getting along better with my family (parents, siblings, step-parents, etc.)
Organization/time management skills
Improve study skills or learn new study techniques
Reduce test-taking anxiety
Family changes (divorce, separation, remarriage, new sibling, etc.)
Handling peer pressure
Dealing with anger
Making and keeping friends
Improving problem solving skills
Self-control/impulsive behavior
Feeling sad or depressed
Thoughts of suicide
Feeling anxious or nervous
Concerns with drugs/alcohol (self or others)
Concerns with self harm (self or others)
Concerns with eating disorders - (self or others)
Relationship/dating issues
Do you have another topic not listed above that you would like to discuss with me? Please leave it here.
Your answer
Thank you for taking this survey!
Your answer
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