Charter Oak High School Counseling Survey

Name:

I need help with the following Personal concerns:

*Please check one of the following in each row*

Strongly Disagree Agree Strongly

Disagree Agree

Making Friends

Fitting in at School

Getting along with students better

Skills for resolving conflicts

Setting healthy boundaries

I need help with the following school concerns:

*Please check one of the following in each row*

Strongly Disagree Agree Strongly

Disagree Agree

Understanding different pathways

after high school

Understanding the best career

options for me

Understanding graduation
requirements

Selecting a career

Tranistion after highschool

Preparing for adulthood

In which area do you believe you need more help?

◯ Academic Concerns

◯ Personal Concerns

If you could participate in group counseling, which group would benefit

you more?

◯ Future Planning

◯ Building Healthy Relationships

◯ None

Would you participate if one of these groups was offered during school
hours?

◯ Yes

◯ No

Would you be willing to spend lunch in one of these groups?

◯ Yes

◯ No