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8th Grade Student Needs Assessment Survey
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Your email
Needs Assessment
The following questions help us to know how best to serve you as a student and as a whole class.
First Name
*
Your answer
Last Name
*
Your answer
Who do you live with?
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Your answer
Who is the person in which you would confide in if you had a concern?
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Your answer
Name two middle school friends you spend time with at school and/or home?
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Your answer
Favorite hobby or thing to do in your free time?
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Your answer
Activities you participate in school?
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Your answer
What is your dream for the future?
Your answer
What do you want me to know about you as your counselor?
Your answer
For the following questions, mark "yes" for the items that are currently concerns for you.
Difficulty controlling anger
Yes
No
Clear selection
Study skills/grades
Yes
No
Clear selection
Death of a loved one, especially an immediate family member
Yes
No
Clear selection
A problem getting along with friends or others
Yes
No
Clear selection
Bullying/harrassment
Yes
No
Clear selection
Stress
Yes
No
Clear selection
Feeling sad most of the time
Yes
No
Clear selection
Test or school anxiety
Yes
No
Clear selection
For the rest of the questions, mark "yes" if the question is true for you and "no" if it is not.
You feel loved and supported in your family.
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Yes
No
You can go to your parents for advice and support.
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Yes
No
You know at least three adults (besides your parents) you can go to for advice and support.
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Yes
No
You have neighbors who support you, encourage you, and care about you.
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Yes
No
Your school is a caring, encouraging place to be.
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Yes
No
Your parents are actively involved in helping you succeed in school.
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Yes
No
You feel that the adults in your community value and appreciate young people.
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Yes
No
You and other young people are given useful roles and meaningful things to do in your community.
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Yes
No
You do an hour or more of volunteering your time each week.
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Yes
No
You feel safe at home, at school, and in your neighborhood.
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Yes
No
Your family has both clear rules and consequences for your behavior. They also monitor your whereabouts.
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Yes
No
Wadsworth Middle School has clear rules and consequences for behavior.
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Yes
No
Your neighbors take responsibility for monitoring your behavior.
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Yes
No
Your parents and other adults in your life model positive, responsible behavior.
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Yes
No
Your best friends model responsible behavior. They are a good influence on you.
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Yes
No
Your parents and teachers encourage you to do well.
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Yes
No
You spend three or more hours each week in lessons or practice in music, theater, or other arts.
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Yes
No
You spend three or more hours each week in sports, clubs, or organizations at school and/or in the community.
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Yes
No
When you hang out with friends, you have plans.
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Yes
No
You want to do well in school.
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Yes
No
You like to learn new things.
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Yes
No
You do at least one hour of homework every school day.
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Yes
No
You care about your school.
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Yes
No
You spend three or more hours each week reading for pleasure.
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Yes
No
You believe that it’s really important to help other people.
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Yes
No
You want to help promote equality and reduce world poverty and hunger.
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Yes
No
You act on your convictions and stand up for your beliefs.
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Yes
No
You tell the truth – even when it’s not easy.
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Yes
No
You accept and take personal responsibility for your actions and decisions.
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Yes
No
You know how to plan ahead and make choices.
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Yes
No
You’re good at making and keeping friends.
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Yes
No
You know and are comfortable with people of different cultural, racial, and/or ethnic backgrounds.
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Yes
No
You resist negative peer pressure and avoid dangerous situations.
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Yes
No
You try to resolve conflicts nonviolently.
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Yes
No
You feel that you have control over many things that happen.
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Yes
No
You feel good about yourself.
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Yes
No
You believe that your life has a purpose.
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Yes
No
You’re positive about your future.
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Yes
No
When you are done, hit submit and log out of your chromebook.
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