HIMS

Student Needs Assessment

The counselors are surveying the entire school to determine the needs of Hamilton students.
Please write your first and last name, homeroom teacher, and date on the Scantron form. This
survey asks your opinion about your needs and some of the things you are experiencing at
Hamilton. There are no right or wrong answers, but we ask that you take this survey
seriously and be thoughtful about how you respond to the questions.

This survey is private, but not anonymous. Your individual responses will NOT be shared with
your teachers, fellow students, parents or administrators (unless we have concerns over your
immediate safety). We may call you down to check-in with you. The total results of the survey
will help us design activities, small groups, and individual counseling needs for the school.

Please feel free to ask any questions if you become confused about any of the questions on
this survey. Thank you for taking the time to answer this survey! J

Please DO NOT write on this paper. Put all your answers on the Scantron form. Thanks!



Directions: Please rank the following problems in order of importance using the letters A-E.

A = most serious problem at Hamilton
B = 2nd most serious problem at Hamilton
C = 3rd most serious problem at Hamilton
D = 4th most serious problem at Hamilton
E = least serious problem at Hamilton

1. Negative peer pressure (EX: alcohol or drug use, sexual activity, breaking rules)
2. Problems with students who are different from me (EX: race/ethnicity, religion, sexual
orientation)
3. Self-image (EX: body image, depression, extreme academic stress, perfectionism)
4. Violence (EX: bullying, anger outbursts, fights in or out of the classroom)
5. School culture (EX: difficulty fitting in, lack of school spirit, lack of adult support)

HIMS Student Needs Assessment

Directions: For the following items, choose the letter that best represents your opinion.

A=High Priority B=Medium-high C=Medium Priority D= Medium-low E=Low Priority

STUDENTS NEED TO KNOW MORE ABOUT









6. How to deal with peer pressure.



7. How to get along with students who are different from me.
8. How to manage personal stress.

9. How to handle conflict at school.

10. How to fit in at school.

11. How to get good grades.

Directions: Please rank the following topics in order of importance to you using the letters A-E.

A = I need the most help on this topic

B = I need the 2nd most help on this topic
C = I need the 3rd most help on this topic
D = I need the 4th most help on this topic
E = I need the least help on this topic

12. Study Skills (how to prepare for tests or assignments)

13. Time Management (between school, extra curricular, leisure, family, friends)
14. Organization (keeping all your academic materials organized and easy to access)
15. Communicating for help (how and when to ask for it)
16. Test anxiety (calming your nervousness before a test)

HIMS Student Needs Assessment

Directions: Please choose your answers to the questions according to the scale provided.

A=Always B=Frequently C=Sometimes D=Not Often E=Never

17. I am confident about my ability to prepare for a test.

18. Although I have prepared for a test, I feel an overwhelming sense of nervousness just
before taking a test.


19. I am overwhelmed by the amount of activities I am involved in.
20. I turn in my assignments on time.

21. When I need it, I will ask for help on my assignments.

Directions: Please rank the following activities in order of importance using the letters A-E.

A = the most important to you
B = the 2nd most important to you
C = the 3rd most important to you
D = the 4th most important to you
E = the least important to you

22. Identifying my interests.

23. Learning about options after high school.
24. Linking my interests to possible careers.
25. Getting direct instruction on career choices in school.
26. Setting realistic goals.

HIMS Student Needs Assessment

Directions: Please choose your answers to the questions according to the scale provided.

A= extremely confident B= moderately confident C=somewhat confident D= not confident

How confident am I that

27. My career interests are related to my personal skills, abilities and interests.
28. I know what college majors relate directly to my career interests.

29. I can effectively balance schoolwork and leisure time.



30. I can set achievable goals.

Directions: Sometimes during adolescence, students face problems that interfere with
learning. Please read the list below and indicate if the items below have impacted your
learning in middle school.
A= All the time B= Most of the time C= Some of the time D= A little of the time E= Never

31. I feel like I dont have an adult to talk to.

32. I think about or have attempted suicide.




33. I think about cutting or harming myself.



34. I am dealing with the death/loss of a loved one.




35. I am dealing with my parents divorce/separation.


36. I have experimenting or am thinking about experimenting with drugs/alcohol/tobacco.
37. I am concerned about a friend or family member with a drug/alcohol/tobacco problem.
38. I feel sad or depressed.






39. I am concerned about the way I look.






40. I feel anxious or nervous.





41. I have conflicts with my family/sibling.




42. I have low self-esteem.





43. I feel bullied.





44. I have problems with friends/peers.




45. I have difficulty controlling my emotions.





46. I make impulsive decisions.





47. I have trouble standing up for myself.


48. I have a hard time asking for help.

49. Please indicate your gender:

50. Please indicate your grade:

A=Male

th
A=6 grade

B=Female
B=7th grade

C=Other
C=8th grade