21-22 MMS Student Needs Survey

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Your school counselor is someone who can help you with some of the challenges in life. As a school, we want to learn how we can better support our students. Please answer the questions honestly and the best you can. Your responses will remain confidential and will provide us feedback on the resources you may need. Thank you!

Print Your Name (First and Last Name) *

Grade *

Grade 6

Grade 7

Grade 8

How are you feeling right now? *

I'm doing great

I'm okay

I'm having a hard time, but I have the help of my family to support me

I'm having a hard time and wouldn't mind if someone reached out to me

I'm having a really tough time and need help now

Other:

How has your mental health been since school has started? *

Very Bad

Really Great

As you think about yourself, select 3 areas that you think YOU struggle with the most? (please select only 3 options) *

Adjusting to the death of someone close to me

Being bullied/harassed

Dealing with depression

Dealing with family issues

Dealing with the separation or divorce of my parents

Dealing with stress or anxiety

Dealing with thoughts about hurting myself

Doing well in school

Feeling safe at home

Getting along with others

Having a low self esteem

Having help with food, clothing, or housing

Handling peer pressure

Improving my study skills

Making/keeping friends

Managing my time

Managing my anger

I'm doing okay overall

Other:

Required

Pick 1-3 topics that you would be interested in learning more about in a safe and fun Small Group setting with other students. *

Anxiety/Stress

Bullying

College / Career

Depression / Sadness

Divorce

Grief (losing someone close to you)

Healthy Relationships

Making friends

Study / Productivity

I am not interested in attending a small group

Other:

Required

How are you feeling this week? What are you struggling with the most?

When you are struggling with school or mental health, do you feel that teachers and staff have supported you enough? *

Yes I feel that I am supported

Yes but I could use more support

Not really

I get little to no support from teachers and staff

I am nervous to mention that I need help

Other:

Which teacher or staff member do you feel has best supported you and how?

Optional Question: Check the box below if you would like to speak with a counselor or social worker individually (one-to-one) about a personal matter.

Yes, I'd like to speak with my COUNSELOR urgently.

Yes, I'd like to speak with my COUNSELOR within a month's time.

No thank you.

Thank you for taking the time to complete these questions. Please let us know if there is anything else you want to share.

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