JMS Counseling Inventory-Fall 2020 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. OK Question Title * 1. First Name: OK Question Title * 2. Last name: OK Question Title * 3. What grade are you in? 7 8 OK Question Title * 4. Please choose which house you are enrolled in. Alpha Beta Delta Omega OK Question Title * 5. With all the changes related to COVD, overall how are you doing? I am struggling every day I am struggling some days. I am doing okay. I am doing good. I am doing great! I am struggling every day I am struggling some days. I am doing okay. I am doing good. I am doing great! OK Question Title * 6. How many days a week are you home alone during the day? None 1-3 days 4-7 days OK Question Title * 7. 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). Organization/study skills Ways to help resolve conflicts with friends Harassment Gossip Goal Setting Being Assertive Refusal skills (ways to say NO) Healthy Relationships Self-Esteem/Body Image Ways to reduce stress Learning Styles Career Lessons-College/Work Readiness Other (please specify) OK Please read the following and mark any that apply to your or your life. Remember your responses are kept confidential. OK Question Title * 8. Since school started in August, have you had any of the following (Choose all that apply). Feelings of sadness or depression A serious illness/death of a family member or friend. None of these issues. OK Question Title * 9. Since school started in August, have you had any of the following (Choose all that apply). Concerns about a friend's level of alcohol or drug use. Concerns about a family member's level of alcohol or drug use. Concerns about your own level of alcohol or drug use. None of these issues. OK Question Title * 10. Since school started in August, have you felt any of the following (Choose all that apply). Difficulty coping with stress or pressure. Difficulty having healthy relationships with others. Difficulty with your body image or self-esteem. Difficulty dealing with anger. Difficulty dealing with conflicts with friends. Difficulty dealing with feelings of anxiety (feeling nervous and worried a lot). OK Question Title * 11. How many adults outside of school care about you? 0 1-2 3-4 5+ OK Question Title * 12. How many adults in this building care about you and your academic success? 0 1-2 3-4 5+ OK Question Title * 13. I would like more information on: (Choose all that apply). How to get food for myself/or my family. How to get mental health services in the community for myself or a loved one. More information about joining an activity or a club. None of these. Other (please specify) OK Question Title * 14. What is something positve you have learned or can take away from COVID? OK Question Title * 15. What is something that you worry about related to COVID? OK Question Title * 16. Is there anything else you would like your counselor to know about you? No Yes-explain below OK Question Title * 17. Would you like to meet with a School Counselor individually? Yes No OK FINISH