Student Needs Assessment

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Student Instructions: Your 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 your counselor learn what you need.

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

Name (first and last)

Grade

3rd

4th

5th

6th

Clear selection

FeelingI 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

Feeling anxious or worried

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

Clear selection

I feel comfortable seeing my counselor.

Yes

Clear selection

I like school.

Yes

Clear selection

I feel safe at school.

Yes

Clear selection

How did you feel about coming back to school? *

Didn't want to go!

Happy to be back!

You haven't been at school in 5 months! How did things go while you were at home? *

Good! No problems. I enjoyed being home and had fun.

It was fine. Kinda boring.

So so. There were some problems.

Horrible! I need to talk.

Is there anything I should know or that you want to tell me? *

Submit

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