Your child/children are in which grade--select all that apply:
Please check if this is something you are concerned about currently for YOUR child or children at the Middle School:
Very concerned
Somewhat concerned
A little concerned
Not concerned at all
Does not apply
Drug/alcohol use
Making friends
Dating issues
Bullying/excessive teasing
Anger issues
Adjustment to middle school
Peer pressure
Self-esteem/self-confidence
Academic support
Getting along with family
Divorce/separation
Grief/loss of a loved one
Feelings of sadness/ depression
Help with social media issues
Managing stress
Dealing with body image issues
Being organized
Transitioning back from Covid-19
Other
Very concerned
Somewhat concerned
A little concerned
Not concerned at all
Does not apply
Drug/alcohol use
Making friends
Dating issues
Bullying/excessive teasing
Anger issues
Adjustment to middle school
Peer pressure
Self-esteem/self-confidence
Academic support
Getting along with family
Divorce/separation
Grief/loss of a loved one
Feelings of sadness/ depression
Help with social media issues
Managing stress
Dealing with body image issues
Being organized
Transitioning back from Covid-19
Other
If you marked Other, please specify:
Your answer
From the items that you marked Very concerned or Somewhat concerned, please put them in numerical order. Please mark your top 4 concerns. If it is not a concern, mark N/A.
Most concerned (1)
Concern (2)
Concern (3)
Concern (4)
N/A (not applicable)
Drug/alcohol Use
Making friends
Dating/relationships
Bullying/excessive teasing
Anger issues
Adjustment to Middle School
Peer pressure
Self-esteem/self-confidence
Academic support
Getting along with family
Divorce/separation
Grief/loss of a loved one
Feelings of sadness/depression
Help with social media issues
Managing stress
Dealing with body image issues
Being organized
Transitioning back from Covid-19
Other
Most concerned (1)
Concern (2)
Concern (3)
Concern (4)
N/A (not applicable)
Drug/alcohol Use
Making friends
Dating/relationships
Bullying/excessive teasing
Anger issues
Adjustment to Middle School
Peer pressure
Self-esteem/self-confidence
Academic support
Getting along with family
Divorce/separation
Grief/loss of a loved one
Feelings of sadness/depression
Help with social media issues
Managing stress
Dealing with body image issues
Being organized
Transitioning back from Covid-19
Other
Clear selection
Any other suggestions?
Your answer
Would you be interested in having your student participate in a group based on one of your identified topics?
Clear selection
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