Fresh, Soph, Jr Personal Needs Survey

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. Your answers to questions 3-14 will be kept CONFIDENTIAL. Please indicate what type of assistance you would like in each area. Counselors and 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.