School Counseling Needs Assessment Survey

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School Counseling Needs Assessment Survey

Please take a minute to complete the needs assessment survey. The responses collected will be used to determine topics of possible counseling groups. Individual responses are confidential. If a counseling group is formed and you receive a permission slip to attend, your participation is not mandatory.

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First Name: *

Last Name: *

Homeroom: *

Please Choose 1: *

I would like to have help dealing with being separated from my parent/parents.

I DO NOT need help with this topic.

Required

Please Choose 1: *

I would like to have help expressing my anger in a safe way.

I DO NOT need help with this topic.

Required

Please Choose 1: *

I would like to have help improving my study skills and/or organizational skills.

I DO NOT need help with this topic.

Required

Please Choose 1: *

I would like help dealing with stress and anxiety.

I DO NOT need help with this topic.

Required

Please Choose 1: *

I would like to have help with getting food, clothing, or housing.

I DO NOT need help with this topic.

Required

Please Choose 1: *

I would like to have help adjusting to the separation of someone due to them being in jail.

I DO NOT need help with this topic.

Required

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