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What grade are you in?
 
3rd
 
4th
 
5th
 
6th
 
7th
 
8th
 
9th
 
10th
 
 
 
Have you worked with a school counselor before?
 
YES
 
NO
 
NOT SURE
 
 
 
Do you have a school Portfolio or used CareerCruising/CCspark before?
 
Yes
 
No
 
Don't know what that is
 
 
 
I have an Academic and Career Plan?
 
Yes
 
No
 
I don't know what that is
 
 
 
These are the things that concern me…

…about myself:
 
Feeling good about myself
 
Sharing my feelings
 
Changing my behavior
 
Worrying, especially about
 
 
 
These are the things that concern me…
…about friends:
 
Making and keeping friends in school
 
Making and keeping friends at home
 
Gandling teasing, name calling, or fighting
 
Working out problems with friends
 
 
 
These are the things that concern me
… Getting along with teachers
 
Getting along with teachers
 
Getting my school work done
 
Getting my homework done
 
How I feel about myself as a learner
 
 
 
Comments/Suggestions:
   
 
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