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Student Needs Assessment
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.
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Answer each statement and check how true it is for you.
Name
Your answer
Grade
Your answer
I need help with the following PERSONAL concerns...
Making friends
Fitting in better at school
Feeling better about me
Handling teasing
Handling peer pressure
Getting along better with my family
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:
My counselor is available to me.
Yes
No
Clear selection
I feel comfortable seeing my counselor.
Yes
No
Clear selection
I like school.
Yes
No
Clear selection
I feel safe at school.
Yes
No
Clear selection
Anything else you want the counselor to know...
Your answer
Submit
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