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Student Needs Assessment (for Families) 2023-2024
Meigs Academic Magnet School
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* Indicates required question
First Name (of your student)
*
Your answer
Last Name (of your student)
*
Your answer
Which Race/Ethnicity best describes your student?
(Please check only one option)
*
Native American
Asian or Pacific Islander
Black/African American
Hispanic
White/Caucasian
Multiple ethnicities
Prefer not to say
Other:
What grade is your student in?
*
5th
7th
Who is your student's homeroom teacher?
*
Hartfelder
Culp
Nickle
Buckner
Martin
McMurray
Johnson
Boone
Holloway
Neukem
Van Lenten
Walker
Academic and Career/College Interest Needs
My student needs support with Time Management/Organizational Skills...
*
Lowest Need
1
2
3
4
5
Highest Need
My student needs support with Study Skills...
*
Lowest Need
1
2
3
4
5
Highest Need
My student needs support with Test Taking/Test Anxiety...
*
Lowest Need
1
2
3
4
5
Highest Need
My student needs support with Career/College Interests...
*
Lowest Need
1
2
3
4
5
Highest Need
Social/Emotional Needs
My student needs support with Conflict Resolution/Anger Issues...
*
Lowest Need
1
2
3
4
5
Highest Need
My student needs support with Stress/Anxiety...
*
Lowest Need
1
2
3
4
5
Highest Need
My student needs support with Social Skills/Making Friends...
*
Lowest Need
1
2
3
4
5
Highest Need
My student needs support with Family Issues...
*
Lowest Need
1
2
3
4
5
Highest Need
My student needs support with Eating Healthy/Eating Disorder...
*
Lowest Need
1
2
3
4
5
Highest Need
My student needs support with Bullying/Teasing/Peer Pressure...
*
Lowest Need
1
2
3
4
5
Highest Need
My student needs support with Sadness/Depression...
*
Lowest Need
1
2
3
4
5
Highest Need
My student needs support with Self-Esteem/Self-Confidence...
*
Lowest Need
1
2
3
4
5
Highest Need
My student needs support with Self-Harming issues...
*
Lowest Need
1
2
3
4
5
Highest Need
My student needs support with LGBTQ+/Gender Identity...
*
Lowest Need
1
2
3
4
5
Highest Need
My student needs support with Grief/Loss of a loved one...
*
Lowest Need
1
2
3
4
5
Highest Need
Other
(please explain):
Your answer
Counseling Services
I would like for my student to meet with their School Counselor, Mrs. Hotchkiss...
*
Yes, I would like for my student to meet with their school counselor.
No, my student does not need to meet with their school counselor.
Is your student currently seeing a counselor outside of school?
*
Yes
No
Not currently, but they have in the past
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