Counselor Feedback Form - Parents
Dear Parents/Guardians,

The purpose of this survey is to better understand the needs of our students. This information helps us determine which topics we need to address in the classrooms and our small group sessions. We would like your input about the needs of YOUR child. Please complete the survey below. We appreciate you and all that you do.

If you have more than one child attending WA-ASM, please complete a new survey for each child

Parent/Guardian's name *
Your answer
Your child's last name *
Your answer
Your child's first name *
Your answer
Your child's grade *
Using the scale below, please rate each statement about the needs of your child. Think "what does my child need help with, the most?"
1 =Most Important, 2= Important, 3= Somewhat Important, 4= Not important
Making friends *
Preparing for high school *
Asking for help in class *
Getting along better with family members *
Communicating respectfully to adults/teachers/peers *
Controlling anger *
Knowing how to stay out of trouble at school and/or at home *
Being accountable for his/her actions *
Improving study skills *
Avoiding Peer Pressure *
Understanding the feelings of others *
Appreciating his/her body *
Avoiding physical aggression (fighting) *
Reducing text anxiety *
Additional topics not listed
Your answer
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