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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
Fitting in at school
Dealing with peer pressure
Getting invovled in school activities
Dating or relationship issues
Concerns about alcohol and/or drug use
Helping myself (gaining more self-confidence, feeling better about myself, expressing my feelings and thoughts)
Handling teasing or being bullied
Getting along with other students better
Getting along better with family members
Feeling sad or depressed
Grief over the loss of a loved one
Parental divorce or seperation
Dealing with anger
Skills for resolving conflict
I need help with the following academic concerns...
Only select the ones you need help with.
Being more organized
Managing my time better
Improving study skills
Reducing test anxiety
Improving test taking skills
Understanding what my test scores mean in relation to academic and career planning
Understanding the best career options for me
Planning my options after high school
understanding my learning style to improve how I learn
Understanding graduation requirements
Select only the statements you agree with.
My counselor is available to me when I need to see her.
I feel comfortable going to see my counselor to get help with SCHOOL concerns.
I feel comfortable going to see my counselor to get help with PERSONAL concerns.
My classes keep me interested in the topic.
I like coming to school.
My teachers are willing to help me when I have questions.
The school is involved in developing my education plan.
I understand why I need a good education.
I will stay in school until I graduate high school.
I will continue my education after high school.
I understand why I participate in testing.
Have you ever repeated a grade level?
Be honest so that your School Counselor can provide you with proper assistance.
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.
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
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.
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