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Student Needs Assessment
1.
What is your name?
2.
How old are you?
3.
What is your gender?
Female
Male
Other (specify)
4.
Which race/ethnicity best describes you? (Please choose only one.)
American Indian or Alaskan Native
Asian / Pacific Islander
Black or African American
White / Caucasian
Other (please specify)
5.
What is your favorite cartoon?
6.
In what language do you speak most often?
Chinese
English
French
Hindi
Japanese
Korean
Other (please specify)
7.
What is your favorite food?
8.
What are the areas you need help with?
Fear of going to school
Bullying
Paying attention in lessons
Low self-esteem
Gender identity
Divorce and separation in the family
Technology accessibility
Health issues
Poverty
Other (please specify)
Current Progress,
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