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Elementary School - Guidance Curriculum Assessment
PARENT SURVEY

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* 1. Student’s Name:

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* 2. Parent’s Name:

ACADEMIC DEVELOPMENT
Please rate your student’s ability to accomplish the following ASCA Standards Indicators.
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* 3. Takes pride in work and in achievement

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* 4. Uses communication skills and knows when and how to ask for help when needed

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* 5. Articulates feelings of competence and confidence as a learner

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* 6. Accepts mistakes as essential to the learning process

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* 7. Takes responsibility for his/her actions

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* 8. Demonstrates the ability to work independently

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* 9. Understands the relationship between classroom performance and success in school

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* 10. Can set goals for himself/herself

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* 11. Identifies personal skills, interests, and abilities

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* 12. Knows how to use conflict management skills with peers

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* 13. Has a positive attitude toward self as a unique and worthy person

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* 14. Identifies and expresses feelings

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* 15. Distinguishes between appropriate and inappropriate behaviors

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* 16. Knows how to make and keep friends

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* 17. Understands the need for self-control and how to practice it

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* 18. Demonstrates cooperative behavior in groups

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* 19. Recognizes, accepts, respects, and appreciates individual differences

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* 20. Recognizes, accepts, and appreciates ethnic and cultural diversity

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* 21. Understands consequences of decisions and choices

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* 22. Knows when, where, and how to seek help for solving problems and making decisions

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* 23. Demonstrates knowledge of personal information (i.e., telephone number, home address, emergency contact)

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* 24. Demonstrates the ability to assert boundaries, rights, and personal privacy

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* 25. Takes responsibility for actions at home

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* 26. Assists with household duties (chores)

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* 27. Participates in the care of someone else or thing (pet, sibling, plant, etc.)

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* 28. Goes to bed on time

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* 29. Keeps personal area tidy (e.g. bedroom)

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