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Student Needs Assessment
I need your help to develop this year’s counseling program. Please respond honestly to help develop our school counseling program.
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What grade are you in?
K
1st
2nd
3rd
4th
5th
6th
I know the school counselor.
Yes
No
Clear selection
The school counselor can be help you with anything that is bothering you.
Agree
Disagree
I'm not sure.
Clear selection
The school counselor visits classrooms and meets with students individually and in small groups.
Agree
Disagree
Clear selection
If I need to speak to the school counselor I can let the counselor or the teacher know.
Yes
No
Clear selection
What are the most important topics for me to teach your class in counseling this year?
Making Friends
Not Needed
1
2
3
4
5
Highly Needed
Clear selection
Resolving Conflicts
Not Needed
1
2
3
4
5
Highly Needed
Clear selection
Career Awareness
Not Needed
1
2
3
4
5
Highly Needed
Clear selection
Changes in Family (Divorce or Separation)
Not Needed
1
2
3
4
5
Highly Needed
Clear selection
Grief and Loss
Not Needed
1
2
3
4
5
Highly Needed
Clear selection
Bullying
Not Needed
1
2
3
4
5
Highly Needed
Clear selection
Self-Esteem ( Understanding Self and Others)
Not Needed
1
2
3
4
5
Highly Needed
Clear selection
Would you be willing to participate in small group counseling session?
Yes
No
Maybe
Clear selection
On a scale from 1 -5, how would you rate the importance of school counseling.
Not Important
1
2
3
4
5
Very Important
Clear selection
What problems at our school would you like to see the school counselor solve?
Your answer
Any additional comments you would like to share with the school counselor.
Your answer
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