JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
LPP at OCC 2023-2024 Student Questionnaire
Today is going to be a great day!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Student's First Name
*
Your answer
Student's Last Name
*
Your answer
Current Cell Phone Number
*
Your answer
Name of Your School
*
Choose
Corcoran HS
Henninger HS
Huntington K-8
ITC
Lafayette Jr./Sr. HS
Nottingham HS
PSLA @ Fowler
Syracuse STEM @ Blodgett
The Big Picture School
Current Grade Level
*
7th
8th
9th
10th
11th
12th
How can LPP at OCC help you succeed?
*
Improve my grades
Help keep good grades
Help me stay on track/Stay focused on my goals and achieve them
Help me prepare for life after high school (college, find full-time work, military)
Help me with dealing with challenges in life
Help me stay out of trouble
Check in with me regularly about how I doing with things at school and at home
Help me get connected to other positive people and programs to help me succeed
Help me get connected to other students in my school doing positive things
Help me improve my leadership abilities
Other
Required
If selected "Other," please explain below
*Note (If "Other" was not selected, please respond in the field below with "N/A")
*
Your answer
If you are dealing with challenging situations at school or at home that LPP can help with, please tell us more about what you are dealing with/struggling with (feel free to list the areas of concern)
*
Your answer
Identify one thing about yourself that you are proud of
*
Your answer
Are you currently worrying about anything or stressed out about anything?
*
Yes
No
If you answered yes, please explain the cause of worry/stress
*
Your answer
Is there anything causing you added anxiety or feelings of being overwhelmed?
*
Yes
No
If you answered yes, please explain the cause of your anxiety or feeling overwhelmed
*
Your answer
Select at least 3 emotions that you would help explain how you are feeling
*
Happy
Sad
Scared
Worried
Confused
Angry
Silly
Surprised
Bored
Frustrated
Confident
Excited
Other
Required
If you selected "Other," please explain how you're feeling
*Note (If "Other" was not selected, please respond in the field below with "N/A")
*
Your answer
If there is other important information you would like us to know that will help us help you, please share below
*
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
