Student Diagnostic Assessment Questionnaire
Please complete this questionnaire to help us understand your academic strengths, learning preferences, and support needs.
Student Full Name
*
First Name
Last Name
Student Email Address
*
example@example.com
Grade Level
*
Please Select
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Other
School Name
*
Academic Skills Self-Assessment
*
Rows
Needs Improvement
Satisfactory
Excellent
Reading Comprehension
1
2
3
Mathematics
4
5
6
Writing
7
8
9
Science
10
11
12
Critical Thinking
13
14
15
Preferred Learning Style
*
Visual (seeing, reading)
Auditory (hearing, listening)
Kinesthetic (hands-on, doing)
No preference
How confident do you feel in the following areas?
*
Rows
Not Confident
Somewhat Confident
Very Confident
Participating in class discussions
16
17
18
Completing assignments on time
19
20
21
Taking tests/exams
22
23
24
Asking for help when needed
25
26
27
Which subjects do you find most challenging? (Select all that apply)
Mathematics
Science
English/Language Arts
Social Studies
Foreign Language
Other
On a scale of 1 to 5, how motivated are you to improve your academic performance?
*
Not motivated
1
2
3
4
Highly motivated
5
1 is Not motivated, 5 is Highly motivated
Do you require any additional support or accommodations to succeed academically?
*
Yes
No
If yes, please describe the support or accommodations you need.
Is there anything else you would like your teachers or school to know to help you succeed?
Submit Assessment
Should be Empty: