Student Needs Assessment

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1. What is your name?

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2. How old are you?

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3. What is your gender?

Female

Male

Other (specify)

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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)

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5. What is your favorite cartoon?

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6. In what language do you speak most often?

Chinese

English

French

Hindi

Japanese

Korean

Other (please specify)

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7. What is your favorite food?

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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)

Student Needs Assessment

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* 1. What is your name?

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* 2. How old are you?

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* 3. What is your gender?

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* 4. Which race/ethnicity best describes you? (Please choose only one.)

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* 5. What is your favorite cartoon?

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* 6. In what language do you speak most often?

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* 7. What is your favorite food?

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* 8. What are the areas you need help with?

1. What is your name?

2. How old are you?

3. What is your gender?

4. Which race/ethnicity best describes you? (Please choose only one.)

5. What is your favorite cartoon?

6. In what language do you speak most often?

7. What is your favorite food?

8. What are the areas you need help with?