Graduate Polk: Student Success Center Survey - Cedartown Middle School

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* 1. In general, how would you rate your overall mental and emotional health?

Excellent

Good

Fair

Poor

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* 2. How familiar are you with the mental health services offered through the Student Success Center

Extremely familiar

Very familiar

Somewhat familiar

Not so familiar

Not at all familiar

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* 3. How likely are you to participate in anger management groups?

Most likely

Possibly

Not likely

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* 4. How likely are you to participate in stress management groups?

Most likely

Possibly

Not likely

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* 5. How likely are you to participate in groups/activities led by peers?

Most likely

Possibly

Not likely

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* 6. How likely are you to participate in individual therapy?

Most likely

Possibly

Not likely

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* 7. How likely are you to participate in group therapy?

Most likely

Possibly

Not likely

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* 8. Are you struggling with any of the following?

Depression

Grief

Homelessness

Sexual abuse

sexual identity

Domestic violence

Stress

Cutting/Self harm

Substance abuse

Suicidal thoughts

Incarcerated parents

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* 9. Are you struggling with any issues not listed above?

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* 10. Are there any other services you would like to see offered?

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* 11. You are NOT required to provide your contact information. However, in providing the information below we will be able to provide you (and possibly your family) more immediate and personalized assistance. Your information will be kept strictly confidential to those individuals who work in the Student Success Center. If you do not feel comfortable providing this information at this time but decide later you would like to do so, please contact your school counselor.