Student Needs Assessment
This is a short survey to assist the school counselor, Mrs. Martin, to best serve you. There are no right or wrong answers, but I ask that you take this survey seriously. This survey is confidential and your individual responses will not be shared with your teacher or fellow classmates.

Thanks for your time! :)
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First & Last Name   (*You do NOT have to list your name if you do not wish.)
Choose which class you are in: *
Pick 3 topics below you would like for the counselor to address this year: *
Required
Questionnaire
Please rank the following statements on a scale of 1 to 4. (1 Never - 4 Always)
I am confident about my ability to prepare for a test. *
Never
Always
I turn in my assignments on time. *
Never
Always
When I need help, I will ask for it. *
Never
Always
I feel confident about my ability to take charge of my own education and learning. *
Never
Always
I know how to deal with peer pressure. *
Never
Always
I know how to handle conflict. *
Never
Always
I know how to manage stress. *
Never
Always
I feel included at school. *
Never
Always
If you were absent more than 5 days last year, what was the reason? *
Required
Complete the following statement.
When it comes to career planning, I need the MOST help with:
I have a teacher/adult to talk to if I'm having a problem at school. *
List any other topics you would like to see addressed this year with your school counselor.
If you would like to meet the counselor, Mrs. Martin, please type a topic that you would like to discuss.
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