Confidential Survey
Dear Admitted BSA Students and Families,

Broome Street Academy offers so many services that students can access aside from academics! If you feel you need or want therapeutic support, there are four social workers on staff that provide counseling for students both in groups and individual settings. We are happy to work with you to create a less stressful transition to BSA, as well as create a healthy learning environment complete with all of the support you need.

In an effort to understand your needs, here is a brief survey that will remain confidential within the social work department. We’d love to hear from you and be able to outreach to you about the support we can provide throughout the school year.

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Child's Name
Caregiver Name (who is filling this out)
Best Email address
Best Phone Number(s)
Has your student had support from a therapist or mental health professional before? *
If you answered "yes" to number one, please explain a bit about the circumstances, and what services the student had in place.
Has your student ever been diagnosed with any medical or mental health issue that you feel would be helpful for the BSA therapeutic staff to know? Again, this is confidential. *
Do you currently OR have you ever been involved with: *
Required
Can you share a bit about your student with regard to the answers to the previous question? Any info that would help the therapy staff with your student will be helpful.
Are you interested in your student meeting a school counselor? *
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