RHMS 6th Grade Student Needs Assessment

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This is a short questionnaire about you and what you need. This is confidential/private between you and Ms. Chaney.

Email *

I need or want help with the following (check ALL that apply) *

Communicating with parents

Getting good grades

Making friends / Fitting in

Feeling left out with peers

Dealing with bullies

Standing up to peer pressure

Making decisions in boy/girl relationships

Helping myself (gaining more self-confidence, feeling better about myself, expressing my feelings and thoughts)

Dealing with anger and frustration

Getting involved with school activities

Feeling sad or depressed

Parent divorce or separation

Sadness over the loss of a loved one

Skills for resolving conflicts/problems with others

Anxiety/Worrying

Learning more about myself (my personality, my interests, my strengths, and what I am good at)

Figuring out what I want to be when I grow up

Required

I need help with something not listed. Please write what you need with help with below:

Please check any of the items below that you may need more help with: *

I need help being more organized

I need help managing my time better

I need help reducing testing anxiety

I need help with my test taking skills

I do not need help with any of these organizational or testing strategies

Required

My closest friend at RHMS is...

I need Ms. Chaney to know this about me... (optional)

First and Last Name (optional)

Submit

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