School Counseling Student Needs Assessment Grades 4-8
Student Last Name: *
Your answer
Student First Name: *
Your answer
Classroom/Homeroom Teacher: *
Your answer
Grade Level: *
Do you know where the Mrs. Brooks's room is located? *
I know how to contact the Mrs. Brooks.
How is your school year going so far? *
My school year is going TERRIBLE!
My school year is going AWESOME!
Do you have friends at school? *
I am in need of school supplies. *
My family needs food sent home on a regular basis. *
I have at least one adult in my life I feel comfortable talking to. *
Is there anything you would like to talk to Mrs. Brooks about? *
Required
These are areas that concern me about MYSELF. *
Required
These are areas that concern me about SCHOOL. *
Required
These are things that are currently concerning me about FRIENDS. *
Required
These are things that are currently concerning me about HOME. *
Required
I would be interested in being in a small group to learn more about some of my interests/concerns. For example: friendship, grief, academic success, college/career exploration. *
Required
Please list here any topics that you would be interested in learning more about. *
Your answer
Name at least one career that interests you OR that you would like to learn more about. *
Your answer
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