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Local Counseling Needs - Secondary STUDENT Survey

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Local Counseling Needs - Secondary STUDENT Survey Powered By Docstoc
					                                              Name of School

         LOCAL COUNSELING NEEDS  SECONDARY STUDENT SURVEY

Instructions: Check items that are concerns for you.
Note: This survey is voluntary.


                                              CONCERNS                           CHECK

 1   Dealing with change/new situations

 2   Difficulty controlling anger

 3   Receiving one or more failing grades on a report card

 4   Fights

 5   Having a 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/harassment

11   Teenage pregnancy

12   Stress

13   Hurting/cutting oneself

14   Thinking/talking about suicide

15   Feeling sad or depressed most of the time

16   Rumors and gossip

17   Dropping out of school

18   Eating disorders

19   Not accepting people’s differences

20   Afraid to come to school

21   Fear of making mistakes

22   Skipping school

23   Test anxiety

24   Not getting along with teachers

25   Family addictions

26   Not having at least one adult at school I can talk to if I have a problem

27   Feeling unsafe at school

				
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posted:11/23/2011
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