CONFIDENTIAL Student Needs Assessment
survey for students grades 6-8 at the beginning of the 20-21 school year
Email address *
What is your name? *
What community are you assigned to? *
Tell me something interesting about you. *
Tell me a little bit about how online learning went for you in the spring. *
What concerns do you have for the new school year? *
How confident are you that you will be able to be successful with online learning this fall? *
I am really worried- Online learning does not work for me
Extremely confident-not worried at all
Everyone has been affected by COVID-19. Some students have people in their family who have been diagnosed while others have just felt lots of stress and anxiety about the virus. How has living through this virus affected you?
Rate your stress/anxiety about COVID-19. *
I worry about it all the time
No stress, its whatever
The murders of George Floyd, Ahmaud Arbery, and Breyonna Taylor by police this summer have caused lots of unrest and trauma in kids and adults. How has it affected you?
Rate your trauma/stress/anxiety about this summer's police brutality and resulting protests and unrest. *
I worry about it a lot and don't feel great
I think I am handling it well
Have there been any significant changes in your life in the last 12 months? (ie. dog died, mom had a baby, friend moved away, etc) *
Please indicate if you would like to be included in any of the following counseling groups this year (mark all that apply)
If you are new to Lakewood Montessori this year, would you be interested in participating in a social lunch group that could help you make some new friends?
Clear selection
Is there anything else that you want me to know?
Never submit passwords through Google Forms.
This form was created inside of Durham Public Schools.