Student Support Survey
Your school counselors would like to know more about you and what areas of need you may have for the upcoming school year.  We try to offer support to all students through faculty and staff connections, support groups, and check-ins with your counselor.  Please take a few minutes to answer the following questions to let us know more about you and what needs you may have this school year.
Email *
First Name *
Last Name *
Current Grade Level *
Required
How do you attend school? *
Required
Homeroom Teacher *
Team *
1.  Our goal at the middle school is to strive for all students to make a positive connection with at least one adult in the building. At this time, can you identify an adult in this building you could go to if you needed help?  *
Required
2.  Check ONE of the following adults in the middle school building you would go to if you needed help or support. If you cannot name an adult, scroll to the end of this list and check NONE. *
3. Check ONE (not same person as last question) of the following adults in the middle school building you would go to if you needed help or support. If you cannot name a second adult, scroll to the end of this list and check NONE. *
4. Check ONE (not same person as last question) of the following adults in the middle school building you would go to if you needed help or support. If you cannot name a third adult, scroll to the end of this list and check NONE. *
5.  How often would you like to check in with your school counselor this year? If you are not attending school physically in the building (Cougar Academy) we can set up an ms teams meeting with you to check in and touch base. *
Required
6.  Do you have difficulty making and keeping friends or getting along with others? *
7.  Are you currently or recently feeling depressed? (sad, lonely, irritated,  or trouble sleeping) *
8.  Would you like to improve your communication and relationships with your family members? *
9.  Do you struggle with feeling good about yourself and finding your positive qualities? *
10.  Do you feel you need help with organization, study strategies, and/or time management in order to help you improve your grades? *
11.  Do you feel you could use support in dealing with the loss of a family member or someone close to you? *
12.  Do you need support in dealing with divorce/separation of parents? *
13.  Do you need support to manage intense feelings of frustration and anger? *
14.  Do you often feel overwhelmed, worried or anxious? *
15.  Do you have an interest in eating lunch in a small group with your counselor and other students once a week for approx. 6 weeks (time to be determined by your counselor)? *
16. Would you be interested in serving as a student ambassador to help students who are new to our school (this would involve helping them find their way to classes the first few weeks, sitting with them and helping them at lunch and introducing them to other students)? *
17. Would you be interested in serving as tech support for students who are new to our school (this would involve helping them set up their iPads, downloading and showing them how to use their apps, etc.)? *
18. Would you be interested in being a peer mentor to other students who might need academic or  organizational help?  Mentors would be partnered up with one other student and scheduled a time to meet with them during a PAWS period. This program would start in November and run through April of this school year.  More information will be shared with you at a later date if you are interested. *
19.  I am in band? *
20.  I am in choir? *
21.  I am in orchestra? *
22.  Is there anything additional you would like to share with me at this time?
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