Needs Assessment

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Needs Assessment

Hello Miller Macaws!

Hope you and your family are doing well! This is not easy, but my biggest hope is that you are all healthy and safe while you are away from school. Remember, this is TEMPORARY. It will be over.

I have been thinking about YOU and I want to use this google form to provide you an opportunity to address your FEELINGS and any main concerns you have about school. I hope it will give you a place to express how you are feeling about the changes you've experienced.

Please take the time to answer these questions, maybe by doing so you'll have an opportunity to put a name to those feelings of uncertainty.

♥ Your School Counselor♥

Email *

First Name *

Last Name *

Grade *

ID # *

Address of where you currently are: *

How would you like us to contact you? (please provide number if you would like to be called) *

Program you attend: *

I need help in understanding and liking myself better. *

Yes

I need to learn how to deal with peer pressure. *

Yes

I need help with making and keeping friends with people my age. *

Yes

I need to learn how to handle a bullying situation. *

Yes

I need help understanding how to deal with alcohol and drug abuse. *

Yes

I need help adjusting to the death of someone close to me. *

Yes

I need help adjusting to the separation of someone due to jail. *

Yes

I need help dealing with the separation or divorce of my parents. *

Yes

I need help dealing with being separated from a parent. *

Yes

I need help feeling safe at home. *

Yes

I need help expressing my anger in a good way. *

Yes

I need help improving my study skills. *

Yes

I need help dealing with the deportation of a family member. *

Yes

I need help with food, clothing, or housing. *

Yes

I need help dealing with feelings of sadness. *

Yes

I need help dealing with stress or anxiety. *

Yes

I need help exploring and learning more about careers that interest me. *

Yes

I need help understanding A-G requirements and options on how to get to college. *

Yes

I need help with increasing organizational skills. *

Yes

I know one adult that I would talk to at Miller or home if I have a problem. *

Yes

I know at least one adult outside of school that I would talk to if I have a problem. *

Yes

Are you interested in participating in small group (6-10 students) support to address the needs you shared above? Small groups will be held virtually and are open to students in all programs. Students who indicate they are interested in participating in small groups will receive additional information once groups are ready to begin. *

Yes

I would also like my counselors to know that I need help with:

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms