Natural Helpers Survey

This survey affects you! Please complete it carefully. Results from this survey will be used to select and train individuals within the school to provide help to students who want it. Your response IS confidential and anonymous.


  1. I am
    female
    male


  1. I am in grade
    9
    10
    11
    12
    Adult


  1. When I have a problem, I usually try to get help from:
    Friend
    Parent
    An adult at the school (teacher, counselor, etc)
    An adult outside the school
    Brother/Sister


  1. I have been in the Fredonia school system:
    New to Fredonia school's this year
    1-4 years
    5 or more years


  1. Read through the entire list of items below BEFORE you respond.
    Students: Select the top FIVE school concerns that you believe are major issues for you and your friends.
    Adults: Select the top FIVE school concerns that you believe are major issues for the students you work with.
    Abuse (Sexual, Physical, Emotional, or Threats of the same)
    Achievement in school (grades, goals)
    Career or College Choice
    Depression
    Dropping out of school or being suspended or disciplined
    Drug use (marijuana, alcohol, etc)
    Eating disorders (anorexia, bulimia, obesity, weight control)
    Family conflicts (relationships/communications within the family)
    Friendships (jealousy, communications, support)
    Gossip/Rumors
    Loneliness
    Loss (separation, divorce, death)
    Money (school expenses, living expenses, getting a job)
    Peer Pressure
    Popularity (Fitting in, belonging)
    Pregnancy
    Romantic Relationships (Girlfriend/boyfriend)
    Self-Image
    Sex-Related Concerns (sexual/romantic behavior, birth control, sexual identity)
    Sexually Transmitted Diseases (AIDS, Herpes, Chlamydia, Gonorrhea, etc)
    Stress (Not enough time, other pressures)
    Thoughts of suicide, self-destructive actions, and high risk behaviors)
    World Issues (Hunger, War, etc)
    Other


  1. Take a moment and think of the people you trust in this school. Please identify ONE (1) ADULT at this school you trust and with whom you feel comfortable talking about a personal problem with them. INCLUDE FIRST AND LAST NAME!


  1. Please identify ONE (1) MORE ADULT (different from above) at this school you trust and with whom you feel comfortable talking about a personal problem with them. INCLUDE FIRST AND LAST NAME!


  1. Take a moment and think of the people you trust in this school. Please identify ONE (1) STUDENT at this school you trust and with whom you feel comfortable talking about a personal problem with them. INCLUDE FIRST AND LAST NAME!


  1. Please identify ONE (1) MORE STUDENT (different from above) at this school you trust and with whom you feel comfortable talking about a personal problem with them. INCLUDE FIRST AND LAST NAME!