Fresh, Soph, Jr Personal Needs Survey DDE

Please enter your name and ID# in this manner: Last name, First name, ID#
Name: 


A red asterisk (*) indicates required questions.

  1. I am a:*
    Freshman
    Sophomore
    Junior


  1. INSTRUCTIONS: Do not enter any response to question 2. Your answers to questions 3-14 will be kept CONFIDENTIAL. Please indicate what type of assistance you would like in each area listed below. Counselors and/or social workers may contact you this year or next year regarding your answers.


  1. Anger Management  *


  1. Anxiety/Stress management  *


  1. Bullying/Harrassment  *


  1. Depression/Coping Skills  *


  1. Family Conflict  *


  1. Grief/Personal Loss  *


  1. Healthy Relationships/Dating Violence  *


  1. LGBTQ  *


  1. Peer Conflict Resolution  *


  1. Substance Abuse (self or family)  *


  1. Feel free to write in any other social or emotional issue that you would like a counselor or social worker to help you with.
Mr. Reedy