School Counseling Questionnaire

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Hello Miller Macaws!

Each year Miller's Counseling Team reaches out to students so we can plan lessons, small groups, and other activities that provide you with the information and support YOU want most!

We care about you and we want to use this google form to provide you an opportunity to address your FEELINGS and any main concerns you have about school. We hope it will give you a place to express how you are feeling about the changes you've experienced.

Please take the time to answer these questions.

♥ Your Miller Counselors♥

Email *

First Name *

Last Name *

Grade *

ID # *

I want help in understanding and liking myself better.

Yes

Clear selection

I want to learn how to deal with peer pressure.

Yes

Clear selection

I want help with making and keeping friends with people my age.

Yes

Clear selection

I want to learn how to handle a bullying situation.

Yes

Clear selection

I want help understanding how to deal with alcohol and drug abuse.

Yes

Clear selection

I want help adjusting to the death of someone close to me.

Yes

Clear selection

I want help adjusting to the separation of someone due to jail.

Yes

Clear selection

I want help dealing with the separation or divorce of my parents.

Yes

Clear selection

I want help dealing with being separated from a parent.

Yes

Clear selection

I want help feeling safe at home.

Yes

Clear selection

I want help expressing my anger in a good way.

Yes

Clear selection

I want help improving my study skills.

Yes

Clear selection

I want help dealing with the deportation of a family member.

Yes

Clear selection

I want help with food, clothing, or housing.

Yes

Clear selection

I want help dealing with feelings of sadness.

Yes

Clear selection

I want help connecting with peers and adults who will support me for who I am.

Yes

Clear selection

I want help dealing with stress or anxiety.

Yes

Clear selection

I want help exploring and learning more about careers that interest me.

Yes

Clear selection

I want help understanding A-G requirements and options on how to get to college.

Yes

Clear selection

I want help with increasing organizational skills.

Yes

Clear selection

I know one adult that I would talk to at Miller or home if I have a problem.

Yes

Clear selection

I know at least one adult outside of school that I would talk to if I have a problem.

Yes

Clear selection

Are you interested in participating in small group (6-10 students) support to address the needs you shared above? Small groups will be held during the school day, rotating the class period you miss. You will be responsible for making up missed work. Students who indicate they are interested in participating in small groups will receive additional information once groups are ready to begin.

Yes

Clear selection

I would also like my counselors to know that I need help with (connecting with people who support me):

Submit

Clear form

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