Saint Paul Catholic Newman Center; Fresno, California
College Student Health Ministry Needs Assessment Survey
MIND, BODY AND SPIRIT
*
1.
What health-related needs would you like to see addressed at Saint Paul Catholic Newman Center?
Select ALL that apply
(Required.)
Anexiety
Depression
Exercise
Flu/Cold
Insomnia
Nutrition
Vaccinations
Sleep Difficulties
Social Skills
Smoking / Tobacco Use
Suicide
Substance Abuse
Trauma (Abuse - Physical, emotional or financial)
Other (please specify)
*
2.
Select your
TOP
Priority from Question #1
(Required.)
Anxiety
Depression
Exercise
Flu/Cold
Insomnia
Grief/Loss
Nutrition
Vaccinations
Sleep Difficulties
Social Skills
Smoking / Tobacco Use
Suicide
Substance Abuse
Trauma (Abuse - Physical, emotional or financial)
Other Response from question #1
*
3.
Select your
2nd
Priority from Question #1
(Required.)
Anxiety
Depression
Exercise
Flu/Cold
Insomnia
Grief/Loss
Nutrition
Vaccinations
Sleep Difficulties
Social Skills
Smoking / Tobacco Use
Suicide
Substance Abuse
Trauma (Abuse - Physical, emotional or financial)
Vaccinations
Other Response from question # 1
*
4.
Select your
3rd
Priority from Question #1
(Required.)
Anxiety
Depression
Exercise
Flu/Cold
Insomnia
Grief/Loss
Nutrition
Vaccinations
Sleep Difficulties
Social Skills
Smoking / Tobacco Use
Suicide
Substance Abuse
Trauma (Abuse - Physical, emotional or financial)
*
5.
What Availibility of Resources / Programs would you like to see?
Select ALL that apply
(Required.)
Chronic /Terminal Illness
Employment Opportunities
Financial Assistance
Heathcare/ Health Services (Access to Care, Insurance, Health Care Decision Making)
Quality Education
Other (please specify)
*
6.
Select your
TOP
Priorty from Question #5
(Required.)
Chonic Terminal Illness
Employment Opportunities
Financial Assitance
Heathcare/ Health Services (Access to Care, Insurance, Health Care Decision Making)
Quality Education
Other Response from question #5
*
7.
Select your
2nd
Priority from Question #5
(Required.)
Chronic /Terminal Illness
Employment Opportunities
Financial Assistance
Heathcare/ Health Services (Access to Care, Insurance, Health Care Decision Making)
Quality education
Other Response from Question #1
*
8.
Select your
3rd
Priority from Question #5
(Required.)
Chronic / Terminal Illness
Employment Opportunities
Financial Assistance
Heathcare/ Health Services (Access to Care, Insurance, Health Care Decision Making)
Quality education
Other response from question #1
9.
Other comments that are relative to this survey?