1. I feel safe at Nathan Hale.

2. My culture/ethnicity is valued and

represented at NHHS.
3. I participate and/or involved in extracurricular activities
and organizations at NHHS.
. I feel listened to and understood !y "y teachers.
#. $hen I%" in class I often &orry a!out other things 'e.g.(
fa"ily( friends( &or)*.
+. I feel accepted !y "y class"ates.
,. I have plans to attend a 2 or year college after high school.
-. .here is at least one adult in NHHS I can go to &ith a
concern/pro!le".
1 2 3
1 2 3
1 2 3
1 2 3
1 2 3
1 2 3
1 2 3
1 2 3
Nathan Hale High School - Counseling Office
Directions: /lease read each 0uestion carefully and 1H213 the ans&er that
!est fits for you. 4e"e"!er( please !e honest &ith your ans&ers and all
ans&ers are anony"ous.
5rade 6evel7 88 9
th
88 1:
th
8811
th
8812
th

5ender7 88Male 88;e"ale 88<ther 88/refer Not to =ns&er
2thnicity7
o ="erican Indian/ =las)an Native
o =sian
o ;ilipino//acific Islander
o Hispanic/1hicano/6atino
o >lac)/=frican ="erican
o $hite/1aucasian
o <ther 88888888888888888888
Place a checkmark beside each statement that is important to you.
=s a student( I &ould li)e to )no& "ore a!out7
o =d?usting to High School
o Solving pro!le"s @ "a)ing good decisions
o I"proving "y study @ testAta)ing s)ills
o 2xploring "y culture/ethnicity
o Setting goals for "yself and carrying the" out
o 2xploring future career choices
o Managing conflict &ith others
o Bealing &ith social pressure and stress
o 6earning "ore a!out drugs and alcohol
o Bealing &ith changes happening in "y fa"ily
o Ma)ing ;riends
o <ther7 88888888888888888
From the list above, which three topics are most important to you?
If a group was offered for any of the above topics would you be interested in participating?
If so( please provide your na"e7
Carefully read the questions below. Please CIC!" the answer that best fits for you, as this
will help the counseling department know
how to support students better.
# $ Strongly =gree % $ =gree & $ Bisagree ' $ Strongly Bisagree
Is there anything the counseling department can do to better help support you?
'/lease use the !ac) of the paper to ans&er this 0uestion*
8888I &ould li)e to "eet &ith "y counselor in person to tal) a!out this issue
Nathan Hale High School - Counseling Office