I would like your help in gauging interest in special topics This survey can help guide me in developing and providing programs that meet your needs this school year. Please be totally honest in your responses. Only you will know the answers you provide as we include no student identifying information on this survey. PLEASE READ EACH STATEMENT AND MARK THE MOST APPROPRIATE ANSWER CHOICE FOR YOU. Please complete the following survey by Friday May 20th. Thank you for your help and feedback!

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* 1. Please indicate your current grade level.

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* 2. Please list your most pressing concern(s) for this school year. (academic, extracurricular, friendships, teachers, classes, organization, etc.)

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* 3. Please read through the list and rate the importance of each topic of service.

  Least Important Somewhat Important Not Sure Important Very Important
Anger Management
Coping Skills
Changing Families/Divorce
Grief Counseling/Family Illness/Loss
Parent in the Military
Problem Solving
Study Skills/Test Taking Skills
Self Esteem/Self Concept
Friendship/Relationships
Bullying
Social Skills
Incarcerated Parent
Leadership Skills
Conflict Resolution
School Behavior/Cooperation
Goal Setting/Motivation
Tattling/Telling
Dating/Relationship Concerns

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* 4. Of the topics listed in question 3, please select the top 5 topics you feel need to be addressed this school year.

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* 5. Please read each statement and mark the most appropriate, honest answer choice for you. Answer each statement below and check how true it is. "I need help with the following PERSONAL concerns."

  Strongly Agree Agree Neither Agree nor Disagree Dissagree Strongly Disagree
Making friends
Fitting in at school
Dealing with peer pressure
Improving communication
Relationship issues
Getting involved in school activities
Concerns about alcohol and/or drug use
Helping myself (gaining more self confidence, feeling better about myself, expressing my feelings and thoughts.)
Handling teasing or being bullied
Getting along with other students better
Getting along better with family members
Feeling sad or depressed
Feeling suicidal
Grief over the loss of a loved one
Parental divorce or separation
Dealing with anger
Feeling stressed
Skills for resolving conflicts

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* 6. Please read each statement and mark the most appropriate, honest answer choice for you. Answer each statement below and check how true it is. "I need help with the following SCHOOL concerns."

  Strongly Agree Agree Neither Agree nor Disagree Dissagree Strongly Disagree
Being more organized
Managing my time better
Improving my study skills
Reducing test anxiety
Improving test taking skills
Understanding what my test scores mean in relation to academic and career planning
Understanding the best career options for me
Planning my options after high school
Understanding my learning style to improve how I learn
Understanding graduation requirements

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