Needs Assessment

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Needs Assessment - 2021

PCH Students and Parents/Guardians,

With the school year underway, we are reaching out to see how you are doing. The form below is another way for you to share with use any needs you or your family may have at this time. The form will close on Monday, September 20 at 3 pm. If, however, a need arises after that time, we encourage you to reach out via email or telephone. Please know that we are here for you and hope that your school year is off to a good start!

Take care and stay safe,

Your PCH Counseling Team

Email *

Student First Name *

Student Last Name *

What physical needs do you need help with? (check all that apply)

Food/toiletries

Technology (internet or a computer for your student)

What social/emotional/academic needs do you need help with? (choose all that apply)

Depression/anxiety

Substance use/abuse

Family counseling

Support for LGBTQ related issues

Mental/physical/emotional abuse

Grief (loss of a loved one or another significant loss)

Study Skills

Making Connections

Other:

Would you want to be a part of a support group here at school centered on the needs you selected above?

Yes

Clear selection

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