Rockwell Student Needs Assessment

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Student Instructions: The school counselor wants to make sure you have access to programs that fit your needs. Please be honest in your answers. Your name and answers will not be shown to anyone else. This survey will help me learn what you need.

Answer each statement and check how true it is for you.

Grade

Column 1

3rd

4th

5th

Clear selection

I need help with the following PERSONAL concerns...

Making friends

Fitting in better at school

Feeling better about me

Handling teasing

Handling peer pressure

Dealing with anger

Dealing with sadness

Feeling Stressed

Other:

I need help with these SCHOOL concerns...

Being more organized

Improving my study skills

Reducing test nervousness

Turning in homework

Other:

I feel comfortable seeing my counselor.

Yes

Clear selection

I like school.

Yes

Clear selection

I feel safe at school.

Yes

Clear selection

Submit

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