Counseling Survey for Parents
Your child's counselor, Mrs. Arney, wants to make sure all students have the BEST school year possible! Your opinion is important, so please answer the following questions. Your answers will help me plan classroom counseling lessons, workshops, small group, and individual counseling throughout the school year.

IF YOU HAVE AN ISSUE IN NEED OF IMMEDIATE ATTENTION, please contact Mrs. Arney at (816) 675-2217 or
Your First and Last Name *
Your answer
Student Name(s) and Grade Level(s): *
Your answer
The following topics are common issues that school-aged students may face. For each topic, please select:
YES - my student could benefit from workshops/lessons, group counseling, or individual counseling regarding this topic.

NO - this issue does NOT affect my student

Please select YES or NO for each topic of interest: *
Questions about college/careers
Learn about scholarships and how to apply
Feeling better about myself (gaining self-confidence)
Coping with teasing/bullying
How to stand up bullying
Illness or death of loved one/friend
Getting along better with my family (parents, siblings, step-parents, etc.)
Organization/time management skills
Improve study skills or learn new study techniques
Reduce test-taking anxiety
Family changes (divorce, separation, remarriage, new sibling, etc.)
Handling peer pressure
Dealing with anger
Making and keeping friends
Improving problem solving skills
Self-control/impulsive behavior
Feeling sad or depressed
Thoughts of suicide
Feeling anxious or nervous
Concerns with drugs/alcohol
Concerns with self harm
Concerns with eating disorders
Relationship/dating issues
Do you have another topic not listed above? Please leave it here.
Your answer
If you wish to be contacted regarding this survey, please leave your phone number or email address here.
Your answer
Thank you for taking this survey!
Your answer
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