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* 1. My name is:

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* 2. The program I am in is:

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* 3. I would like to learn how to study better and/or improve my test-taking skills

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* 4. I would like information about taking or preparing for the ACT.

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* 5. I would like a chance to talk about problems that may hinder my success at school.

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* 6. I need help in math, reading, or language.

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* 7. I would like help with how to protect myself from being hurt.

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* 8. I would like to work on ways to resist negative peer pressure.

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* 9. I need healthy ways of dealing with anger.

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* 10. I need assistance with substance issues (smoking, alcohol, marijuana, or other).

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* 11. I would like to explore my career interests.

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* 12. I would like to develop a plan for a career.

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* 13. I would like help preparing for further education.

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* 14. I would like help with financial aid and/or scholarships.

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* 15. I would like to learn how to resolve problems and conflicts.

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* 16. I want to develop successful communication skills in a variety of situations.

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* 17. I need help with developing healthy relationships.

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* 18. I want to learn how to handle family stressors.

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