Students: Needs Assessment - 11th Grade
All information provided in this questionnaire will be kept confidential. Your name and information will ONLY be used for collecting and addressing student needs.

The school guidance department would like to ensure development of a program that meets your needs. Please be completely honest with your responses. Only you will know the answers you provide. This survey will help us learn how many students need programs and activities on certain topics. Thank you for helping us meet your needs.

Please read each statement and mark the most appropriate answer choice for you.

Please write your first and last name.
Your answer
I need help making better decisions and helping myself (gaining more self-confidence, feeling better about myself, expressing my feelings and thoughts)
No
Yes
I need help handling teasing or being bullied
No
Yes
I need help with getting along better with family members or other students.
No
Yes
I need help with parental divorce or separation
No
Yes
I need help dealing with feelings of anger or stress
No
Yes
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