2017-2018

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* 1. Please check one:

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* 2. Please indicate the appropriate grade level:

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* 3. Various School Counseling services are listed below. Please read through the list and rate the importance of each service. (1 is least important, 4 is very important)

  1. Least Important 2. Somewhat Important 3. Important 4. Very Important
Individual Counseling
Small Group Counseling
Classroom Guidance
Community Agency Referrals
Transition Services (elementary to middle, middle to high school, new students)
Parent Consultation (grades, behavior, social situations)
Standardized Testing
Reporting Abuse/Neglect
Teacher Consultation (grades, behavior, social situations)

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* 4. Please list below other counseling services you feel are important at Glencoe Middle.

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* 5. Please choose the top 5 topics below that you feel need to be addressed.

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* 6. Please check how much you agree with the following statements:

  Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree
My counselor is available to me when I need to see her.
I feel comfortable going to see my counselor to get help with SCHOOL concerns.
I feel comfortable going to see my counselor to get help with PERSONAL concerns.
My classes keep me interested in the topic.
I like coming to school.
I feel safe at school.
My teachers are willing to help me when I have questions.
I have been bullied at school this year.
I understand that bullying is being mean to someone else on purpose, repeatedly.
I have bullied another student this year.

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* 7. Comments

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