2018-2019 Piedmont Middle School Student Guidance Needs Survey for PARENTS

STATEMENT ON INFORMED CONSENT:
Information obtained in a counseling session will not be disclosed to parents, teachers, outside agencies, or other school personnel without student's permission except when such disclosure is necessary to "protect student or someone else from imminent harm" or is otherwise legally and/or required by law such as abuse or neglect of a child, elder, or disabled person. I may also be required to provide information to the court if provided with a court order
Student Name, Optional
Last Name, First Name
Your answer
Student(s) Grade Level *
Required
To better serve your student(s) through individual or small group sessions, please check the following needs or concerns that apply to your student(s) or family. *
Required
Please check the top 3 areas that you think need to be addressed school-wide. *
Required
Please use the space below to share any other information with the school counselor:
Your answer
Submit
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