11/11/23, 5:15 PM JCP CPS Approved HS Needs Assessment

JCP CPS Approved HS Needs

Assessment
PURPOSE OF THIS ASSESSMENT:
The purpose of this needs assessment is to help your school counselor learn which issues
students struggle with most.

HOW WILL THIS ASSESSMENT BE USED?

Your school counselor will use the results of this survey to determine which types of
counseling services to provide to ALL students. In addition, your school counselor may use
the results of this school-wide needs assessment to report out various whole-school
statistics (with no student names) to raise awareness on major issues facing students, to
create classroom lessons, small group interventions that are optional, and potential one-on-
one student supports.

IS THIS ASSESSMENT ANONYMOUS?

No. For your school counselor to follow up with you as needed, they need to know who you
are! Parents will be notified that your school counselor will be giving a school-wide needs
assessment. Student names will not be shared alongside responses with any staff members
outside of the school counseling department. However, anytime while answering the
questions on this needs assessment, you are allowed to discontinue answering any or all of
the questions or discontinue complete the needs assessment in its entirety. You may submit
your answers at any time.

*If at any time, you do not want to answer any more questions, you may stop.

1. First name

2. Last name

3. CPS ID number

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4. Do you know your assigned School Counselor's name?

Mark only one oval.

Yes

No

5. If you know your School Counselor's name list it here.

6. What grade are you in?

Mark only one oval.

9th

10th

11th

12th

7. I agree to complete the Needs Assessment

Mark only one oval.

YES

NO

ACADEMIC ISSUES

Do you feel you need support in the following areas...

"I need a little support in this area" might include occasional check-ins by staff
"I need a lot of support in this area" may include regular tutoring or individual sessions with
appropriate staff

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8. 1. Do you feel you need support with academic goal setting?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

9. 2. Do you feel you need support with working in groups?

Mark only one oval.

1 2 3 4 5

I need a little support in this area

I need a lot of support in this area

10. 3. Do you feel you need support with public speaking/presenting in class?

Mark only one oval.

1 2 3 4 5

I need a little support in this area

I need a lot of support in this area

11. 4. Do you feel you need support with time management and organization?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

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12. 5. Do you feel you need support processing feeling overwhelmed/stressed with
school work, responsibilities, activities?

Mark only one oval.

1 2 3 4 5

I need a little support in this area

I need a lot of support in this area

13. 6. Do you feel you need support with test-taking strategies?

Mark only one oval.

1 2 3 4 5

I need a little support in this area

I need a lot of support in this area

14. 7. Do you feel you need support with processing feelings of being overly nervous or
“blanking out” when taking tests?

Mark only one oval.

1 2 3 4 5

I need a little support in this area

I need a lot of support in this area

15. 8. Do you feel you need support with getting to school on time in the mornings?

Mark only one oval.

1 2 3 4 5

I need a little support in this area

I need a lot of support in this area

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16. 9. Do you feel you need support with raising your grades?

Mark only one oval.

1 2 3 4 5

I need a little support in this area

I need a lot of support in this area

17. 10. Do you feel you need support with finding out which extracurricular activities are
offered?

Mark only one oval.

1 2 3 4 5

I need a little support in this area

I need a lot of support in this area

18. 11. Do you feel you need support with deciding which extracurricular activities are
right for you?

Mark only one oval.

1 2 3 4 5

I need a little support in this area

I need a lot of support in this area

19. 12. Do you feel you need support with learning how to ask for what you need from
your teachers (about anything school-related, such as needing extra help)?

Mark only one oval.

1 2 3 4 5

I need a little support in this area

I need a lot of support in this area

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SOCIAL/EMOTIONAL ISSUES

Do you feel you need support in the following areas...

"I need a little support in this area" might include occasional check-ins by staff
"I need a lot of support in this area" may include regular tutoring or individual sessions with
appropriate staff

20. 1. Do you feel you need support with learning how to deal with change, new
situations or events (either positive or negative)?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

21. 2. Do you feel you need support with learning how to manage stress?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

22. 3. Do you feel you need support with learning how to not constantly be afraid of
making mistakes/wrong decisions?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

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23. 4. Do you feel you need support with learning how to have confidence in yourself?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

24. 5. Do you feel you need support with learning how to avoid feeling worried a lot of
the time?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

25. 6. Do you feel you need support with learning how to process feelings from racism,
being harassed, teased, or bullied at school?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

26. 7. Do you feel you need support with learning how to process feelings from racism,
being harassed, teased or bullied online or through texts?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

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27. 8. Do you feel you need support on learning how to control anger?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

28. 9. Do you feel you need support with learning self-control?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

29. 10. Do you feel you need support with learning how to resolve conflicts?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

30. 11. Do you feel you need support in processing feelings of being lonely?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

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31. 12. Do you feel you need support with learning how to get along with other
students?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

32. 13. Do you feel you need support with being valued for who you are by your peers?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

33. 14. Do you feel you need support with learning how to make or keep friends?

Mark only one oval.

1 2 3 4 5

34. 15. Do you feel you need support with learning healthy coping skills (i.e. instead of
lashing out, over/under eating, causing self-harm, thoughts of suicide, or use of
alcohol or drugs)?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

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35. 16. Do you feel you need support with getting along with teachers?

Mark only one oval.

1 2 3 4 5

I need a little support in this area

I need a lot of support in this area

36. 17. Do you feel you need support with processing feelings of not “fitting into” your
school community?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

37. 18. Do you feel you need support with learning how to avoid peer pressure to do
things you're uncomfortable with?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

38. 19. Do you feel you need support with learning how to feel comfortable with your
body image?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

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39. 20. Do you feel you need support with feeling safe at school?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

40. 21. Do you feel you need support in learning how to cope with the loss of a close
friend or family member?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

41. 22. Do you feel you need support with learning how to process feelings about a
family transition (examples may include but not limited to divorce, remarriage, or a
family member moving in/out)?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

42. 23. Do you feel you need support with learning how to resolve conflict with friends
and/or family members?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

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11/11/23, 5:15 PM JCP CPS Approved HS Needs Assessment

43. 24. Do you feel you need support with learning how to communicate better with
your parents/guardians?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

44. 25. Do you feel you need support with learning how to resolve dating/relationship
issues?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

45. 26. Do you feel you need support with processing feelings from being physically or
emotional harmed by a significant other?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

46. 27. Do you feel you need support with processing feeling sad most of the time?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

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47. 28. Do you feel you need support with processing feelings or navigating hardships
related to sexual orientation or gender identity?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

48. 29. Do you feel you need support with learning more information on protection from
sexually transmitted infections?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

49. 30. Do you feel you need support with learning more information on protection from
pregnancy?

Mark only one oval.

1 2 3 4 5

I need a little support in this area.

I need a lot of support in this area.

50. 31. Do you feel you need support with learning more information about pregnancy?

Mark only one oval.

1 2 3 4 5

I need a little support in this area

I need a lot of support in this area

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51. 32. Do you feel you need support with learning more information about parenting?

Mark only one oval.

1 2 3 4 5

I need a little support in this area

I need a lot of support in this area

52. 33. I am interested in learning more about ________ (check all that apply).
If you need more information to answer the question, use these links.
Mindfulness & Meditation:
https://www.headspace.com/mindfulness
Positive Self-Talk: https://positivepsychology.com/positive-self-talk/
Self-Care: https://www.everydayhealth.com/self-care/

Check all that apply.

Mindfulness and Meditation

Positive Self-Talk
Individual Counseling
Group Counseling
Stress Management
Self-Care
None of the above

Other:

Supports

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11/11/23, 5:15 PM JCP CPS Approved HS Needs Assessment

53. 1. If you indicated you needed average to a lot of support to any of the questions
above, in what way can we BEST support you?

Mark only one oval.

Individual check-in/s with my counselor

Weekly small group meetings (during school day, alternating periods for 8 weeks)

Weekly open office "Lunch Bunch" during lunch periods on different topics

I don't need any extra support from my counselor at this time, but I'll let you know
if/when I do

Other:

54. 2. If you answered a 3 or higher to any question above, in what is the 2nd best way
can we BEST support you?

Mark only one oval.

Individual check-in/s with my counselor

Weekly small group meetings (during school day, alternating periods for 8 weeks)

Weekly open office "Lunch Bunch" during lunch periods on different topics

I don't need any extra support from my counselor at this time, but I'll let you know
if/when I do

Other:

Understanding School Counselor Confidentiality

Your school counselor is happy to speak with you about any concerns or issues you have.
Your school counselor's CONFIDENTIALITY GUIDELINES - I respect your privacy. What is said
in my office, stays in my office, EXCEPT in the following circumstances:
1. Harm to yourself or others
2. Abuse or neglect
3. Court or other legal proceedings
4. You give me permission to talk to others about what we discussed
Due to being a mandated reporter the school may need to break confidentiality and may not
be able to let you know in advance.

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55. I have read the above information concerning counseling services confidentiality
guidelines.

Mark only one oval.

Yes

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