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Help Ms. Mason get to know you
6th grade 2019-20 Needs Assessment
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First Name
*
Your answer
Last Name
*
Your answer
What team are you on?
Crocodile
Otter
Clear selection
Do you speak a different language? If yes, which one, or two?
Your answer
Who do you live with? (Ex. grandfather, aunt, mom, dad, brother, sister, step-dad, step-mom, depends on the day etc.)
Your answer
Do you have a trusted adult at Reedy Creek you can talk to?
Yes
No
Not yet
Other:
Clear selection
Check the box if you could use help with the topic:
Getting along with others
Friendship
Self-Esteem/Confidence
Decision-Making/Responsibility
Talking to a teacher when I have a problem
Rumors & Gossip
Study Skills/Test Taking Skills
Coping with Divorce/Separation/Family Changes
Grief/Loss
Anger Mangement
Understanding/Coping with Feelings
Managing Anxiety & Stress
Feeling sad or down often
Fear of making mistakes
Career Exploration
Test Anxiety
Social Media Safety
Organization
What is the lowest passing grade/percentage?
50
59
60
70
Clear selection
Has anyone in your family graduated from college?
Yes
No
Some college courses
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Do you know what you want to do after high school?
Attend College
Get A Job
Join the Services
Not Sure
Clear selection
What would you like the school counselor to know about you?
Your answer
Right now, my biggest concern about 6th grade is...
Your answer
Right now, the thing about this year that excites me the most is...
Your answer
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