Student Needs Assessment 2022-2023
Meigs Academic Magnet School
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Which Race/Ethnicity best describes you? *
What grade are you in? *
Who is your homeroom teacher? *
Academic and Career/College Interest Needs
I need help with Time Management/Organizational Skills (1= lowest need, 5=highest need) *
I need help with Study Skills (1= lowest need, 5=highest need) *
I need help with Test Taking/Test Anxiety (1= lowest need, 5=highest need) *
I need help with Career/College interest (1= lowest need, 5=highest need) *
Social/Emotional Needs
I need help with Conflict Resolution/Anger Issues (1= lowest need, 5=highest need) *
I need help with Stress/Anxiety (1= lowest need, 5=highest need) *
I need help with Social Skills/Making Friends (1= lowest need, 5=highest need) *
I need help with Family Issues (1= lowest need, 5=highest need) *
I need help with Eating Healthy/Eating Disorder (1= lowest need, 5=highest need) *
I need help with Bullying/Teasing/Peer Pressure (1= lowest need, 5=highest need) *
I need help with Sadness/Depression (1= lowest need, 5=highest need) *
I need help with Self-Esteem/Self-Confidence (1= lowest need, 5=highest need) *
I need help with Self-Harming issues (1= lowest need, 5=highest need) *
I need help with Grief/loss of loved one (1= lowest need, 5=highest need) *
Other (please explain)
Counseling Services
I would like to speak with Mrs. Osborne *
Are you currently seeing a counselor outside of school? *
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