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Student Needs Assessment (Secondary)

Based on your feelings, check the appropriate box for items that are concerns interfering with your learning process. 
1. Dealing with change/new situations
2. Difficulty controlling anger
3. Receiving one or more failing grades on a report card
4. Fighting
5. Having a personal problem with alcohol or drugs
6. A divorce, separation or death in the family
7. Loss of a loved one
8. Loss of a close friend or relationship
9. A problem getting along with friends or others
10. Bullying
11. Harassment
12. Teenage pregnancy
13. Stress
14. Hurting/cutting oneself
15. Thoughts of ending your life
16. Feeling sad or depressed
17. Rumors and gossip
18. Dropping out of school
19. Eating disorders
20. Living away from parents
21. Physical abuse
22. Fear of making mistakes
23. Skipping school
24. Test anxiety
25. Not getting along with teachers
26. Drug and/or alcohol abuse by family members
27. Low self-esteem
28. Communicating with others
29. Sexual abuse or molestation
30. Neglect
31. Inattention/hyperactivity
32. Homelessness
33. Poverty (not having enough money for food or other essential items)
34. Domestic violence in the home
35. Violence within a relationship
36. Study skills
37. Having an adult you can trust
38. Feeling safe at school
39. Family member imprisoned
40. Social anxiety
45. What gender do you identify with?
46. Would you like a counselor to check-in with you?
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