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2019-2020 Students Needs Assessment
First Nine Weeks 2019-2020 School Year
Who is your homeroom teacher? *
Only select one teacher's name.
What is your gender? *
What grade are you in? *
My best subject is... *
I make the best grades in this area
My worst subject is... *
I make lower grades in this area
I need help with the following personal concerns... *
Select only the ones that you need help with
Required
I need help with the following academic concerns... *
Only select the ones you need help with.
Required
Select only the statements you agree with. *
Required
Have you ever repeated a grade level? *
Be honest so that your School Counselor can provide you with proper assistance.
Required
If you answered "yes" to having repeated a grade level and you want information on how to get on track with your age appropriate grade level type your name in the space provided below. *
If you answered "No" to the above question you must type NA in the space provided below in order to move on to the next question.
Your answer
OTHER CONCERNS: Please list any other concerns or needs that were not mentioned that YOU PERSONALLY would like your school counselor to help you with: *
Type in your response below. If you do not have a response you must type N
Your answer
If you would like for me to contact or talk with you about your concerns type your name in the space below *
Please type your name in the space provided below so that I may reach out to you. If you choose not to enter your name you must type NA in order to move submit your survey.
Your answer
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