LRMS Needs Assessment 2017-18
Counselors address the needs of all students and we ask all students to complete this form so we can best serve the Sherwood Middle School student body. This information is held CONFIDENTIAL by the School Counseling Department.
Your First Name
Your answer
Your Last Name
Your answer
What grade are you in?
Tell us about your academic life
This section refers to Academics
False, this does not apply to me.
True, but it doesn't bother me.
True, it bothers me sometimes.
True. I think about it a lot.
I have a hard time staying organized
I have a hard time getting everything done in the week.
I have a hard time with math.
I have a hard time with reading.
I have a hard time with writing.
Tell us about yourself
This section refers to your Self
This is not a problem for me.
This is sometimes a problem.
This is often a problem
I struggle with this most of the time.
I have trouble making friends
I have trouble keeping friends
People bully me
I have lost a family member or close friend (Death)
I worry about what I look like/my body
I have used drugs or alcohol
When I get angry I lose control
I have thought about hurting myself
Tell us about your family
This section refers to your Family
False, this does not apply to me
True, but it doesn't bother me
True. It bothers me sometimes
True. I think about this a lot.
My parents are divorced or planning a divorce
My family fights a lot
At home, my family is violent (hitting, throwing, shaking)
I have a family member who is in jail/prison
I have a family member who drinks too much
I have a family member who is often sick or ill
I have a family member that does a lot of drugs
Where I live, I have access to
All the time
Sometimes
Never
The internet
My favorite LRMS teacher, or the adult I feel most comfortable talking to at LRMS is:
Your answer
If you have additional information to share, please do so here.
Your answer
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