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.
First Name *
Your answer
Last Name *
Your answer
Grade *
Required
Homeroom Teacher *
Required
Team *
1. Do you have at least one adult you feel comfortable talking to, if you have an issue here at school? *
Required
2. Name an adult in the middle school building you feel a positive connection to. Please choose only one option from the following list below: *
Required
3. Name an adult in the middle school building you feel a positive connection to. Please choose only one option from the following list below: *
Required
4. Name an adult in the middle school building you feel a positive connection to. Please choose only one option from the following list below: *
Required
5. How often would you like to check in with your school counselor this year? *
Required
6. Do you have difficulty making and keeping friends or getting along with others? *
Required
7. Do you have trouble sleeping? Do you feel sad, tired, and not wanting to do things you normally would love to do? *
Required
8. Would you like to improve your communication and relationship with your family members? *
Required
9. Do you struggle with feeling good about yourself and finding your positive qualities? *
Required
10. Do you feel you need help with organization, study strategies, and/or time management in order to help improve your grades? *
Required
11. Do you need support in dealing with the loss of a family member or someone close to you? *
Required
12. Do you need support in dealing with divorce? *
Required
13. Do you need support to identify and manage feelings of frustration and anger? *
Required
14. Do you find yourself feeling worried, overwhelmed, or anxious often? *
Required
15. Do you want to socialize, play games, and meet other students in a small group setting over lunch time? *
Required
16. During this school year we are planning on having a peer mentoring program where students can work with one another during PAWS period. *
Required
17. Would you like to be part of a welcoming committee that would be involved in helping new students transition into our middle school? This would include help with finding classes, helping at lunch, etc.
18. I am in band? *
Required
19. I am in choir? *
Required
20. I am in orchestra? *
Required
Submit
Never submit passwords through Google Forms.
This form was created inside of Palmyra Area School District. Report Abuse - Terms of Service