To better serve you, The Counseling Department would like to get to know you and assist you with your needs.  

Your responses are kept confidential and only seen by the Counseling Department.  

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* 1. First Name:

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* 2. Last name:

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* 3. What grade are you in?

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* 4. Please choose which house you are enrolled in.

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* 5. How many hours a week do you spend working at a job that you get paid for?

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* 6. How many hours a week do you spend babysitting (siblings or others)?

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* 7. How many hours a week do you spend at extracurricular activities (sports/clubs/lessons/church groups)?

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* 8. The Counseling Department is wanting to get student views on what you would like the topics to be when the Counselors come into teach guidance lessons. Please select five of the topics you would be interested in. (Students need to check five- or fill in 5 of the responses).

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* 9. The counseling office at JMS periodically offers small group counseling on various topics. Select any groups you would be interested in joining or learning more about (Choose all that apply).

Please read the following and mark any that apply to your or your life. Remember your responses are kept confidential.

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* 10. Since school started in August, have you had any of the following (Choose all that apply).

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* 11. Since school started in August, have you had any of the following (Choose all that apply).

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* 12. Since school started in August, have you felt any of the following (Choose all that apply).

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* 13. How many adults outside of school care about you and your academic success?

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* 14. How many adults in this building care about you and your academic success?

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* 15. I would like more information on: (Choose all that apply).

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* 16. Immediately after high school my primary goal is to...

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* 17. Is there anything else you would like your counselor to know about you?

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