Natural Helpers Survey 2019-20
This survey affects you! Please complete it carefully. Results from this survey will be used to select and train individuals within the school to provide help to students who want it. Your response is confidential and anonymous.
Read each question carefully. Then click on the option that matches your response.
(Please indicate sex assigned at birth.) I am:
I am in grade:
When I have a problem, I usually try to get help from:
an adult at school
an adult outside school
a brother or sister
Directions: Read the entire list of options before you respond.
Only choose your top five options.
Select the top five school concerns that you believe are major issues for you and your friends. (Adults: Select the top five concerns that you believe are major issues for students.)
Abuse (sexual, physical, emotional, or threats of same)
Achievement in School (grades, goals)
Career or College Choices
Depression and Anxiety
Dropping out or being suspended/ disciplined
Drug Use (all substance use)
Eating Disorders (anorexia, bulimia, obesity, weight control)
Family (communication, relationships, conflicts with family members)
Gossip/ Rumors/ Negative Social Media Experiences
Grief/ Loss (separations, divorce, death)
Money (school expenses, living expenses, getting a job)
Popularity (fitting in, belonging)
Romantic Relationships (girlfriend/ boyfriend)
Sex-Related Concerns (sexual/romantic behavior, birth control, sexual identity)
Sexually-Transmitted Infections and Diseases (herpes, AIDS, chlamydia, gonorrhea, etc.)
Stress (not enough time, other pressures)
Thoughts of suicide, self-destructive actions, and high-risk behaviors
World Issues (hunger, war, etc.)
List two adults at this school you trust and with whom you feel comfortable talking about a personal problem. Write their full names if you know them.
Also list the names of two students at this school you trust and with whom you feel comfortable talking about a personal problem. Write their full names if you know them.
Thank you very much for your help!
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