CHS Student Needs Assessment 2012-2013

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Please take a few moments to answer the following questions to help the Counseling office better understand how we may be of assistance! Please answer honestly!

What is your first and last name? *

What grade are you in? *

Please answer the following questions about PERSONAL concerns.

I need help with...handling pressure from friends, teachers, family or myself *

yes

I need help with...learning to stay healthy mentally and physically. *

yes

I need help with...pregnancy/teen parenting. *

yes

I need help with...dating or relationship issues. *

yes

I need help with...concerns about alcohol and/or drug use. *

yes

I need help with...dealing with anger. *

yes

I need help with...feeling sad or depressed. *

yes

I need help with...feeling suicidal. *

yes

I need help with...getting along better with others. *

yes

Please answer the following questions about SCHOOL concerns.

I need help with...transitioning to a new school. *

yes

I need help with...getting involved in school activities. *

yes

I need help with...becoming aware of my career interest areas. *

yes

I need help with...learning about training/educational requirements for jobs I might like. *

yes

I need help with...selecting the right courses for me. *

yes

I need help with...study skills and habits. *

yes

I need help with...reducing test anxiety and/or improving test-taking skills. *

yes

I need help with...time management and organization. *

yes

I know who my school counselor is. *

yes

My counselor is available when I need to see her. *

yes

I feel comfortable going to see my counselor to get help with SCHOOL concerns. *

yes

I feel comfortable going to see my counselor to get help with PERSONAL concerns. *

yes

Someone in the school has regularly helped me plan for my future. *

yes

I will stay in school until I graduate. *

yes

I like coming to school. *

yes

I am involved in at least ONE school activity. *

yes

I have friends at CHS. *

yes

Please list any other concerns or needs that were not mentioned that YOU PERSONALLY would like help with.

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This form was created inside of Carlisle Community School District.