c/o 2022 Student Needs Assessment 2016-2017
Student Instructions:
The purpose of this assessment is to better understand your academic, personal, social and college/career readiness needs for this school year.  Please be totally honest in your responses.  Your responses will help us plan for more student services, as well as, improve the services already in place. Only you will know the answers you provide, as we include no student identifying information on this survey.   PLEASE READ CAREFULLY & ANSWER THOUGHTFULLY.  Mahalo nui, Your Middle School Counselors
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Grade *
Gender *
Advisory *
 I need help with the following PERSONAL/SOCIAL concerns: *
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
Making Friends
Fitting in at School
Dealing with peer pressure
Improving communication
Getting involved in school activities
Dating or relationship issues
Concerns about alcohol and/or drug use
Gaining more self-confidence
Handling teasing or being bullied
Getting along with other students better
Getting along better with family members
Feeling sad or depressed
Self-injury
Feeling suicidal
Grief over the loss of a loved one
Parental divorce or separation
Neglect and abuse
Dealing with anger
Poverty and homelessness
Feeling stressed
Skills for resolving conflicts
Motivation
Eating disorders
Expressing my thoughts & feelings
How often do you use KS Connect to check grades? *
 I need help with the following SCHOOL concerns: *
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
Being more organized
Managing my time better
Improving study skills
Understanding my learning style to improve how I learn
Reducing test anxiety
Improving test-taking skills
Understanding what my test scores mean in relation to academic and career planning
Understanding the best career options for me
Planning my options after high school
Understanding graduation requirements
Last year how often did your teachers speak with you individually about the following? *
For each statement, check the appropriate box.
Never
Once or twice a year
A few times a year
Often during the year
Good academic performance
Poor academic performance
Disrupting class
Not completing an assignment
Interests and things that are important to you
Your plans for after high school
Your worries
Please check how much you agree with the following statements: *
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
My counselor is available to me when I need to see/him or her.
I feel comfortable going to see my counselor to get help with SCHOOL concerns.
I feel comfortable going to see my counselor to get help with PERSONAL Concerns.
My classes keep me interested in the topic.
I like coming to school.
My teachers are willing to help me when I have questions.
The school is involved in developing my education plan.
My counselor has met individually with me least once to help me understand the relevance of the NWEA Test and what my scores mean to me.
My counselor has explained the importance of exploring interests and personal abilities to assist in planning my future.
I understand why I take the NWEA Test.
I understand why I need a good education.
I will stay in school until I graduate high school.
Looking ahead, where do you see yourself after graduation? *
Would you be interested in participating in a small-group about any of the concerns you identified above? *
OTHER CONCERNS: Please list any other concerns or needs that were not mentioned that YOU PERSONALLY would like the school to help you with:
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