Student Therapy Needs Survey Form

Student Therapy Needs Survey Form
Please complete this Student Therapy Needs Survey Form to help us better understand the types of support that may benefit you. All responses are anonymous and non-sensitive.
What is your current grade level?
How would you rate your overall well-being at school recently?
Which of the following areas do you feel you could use more support with? (Select all that apply)
Other
How comfortable do you feel seeking support from school staff if you need it?

1
2
3
4
5
1 is Not comfortable, 5 is Very comfortable
Which type of support would you be most interested in?
Other
Please rate how helpful you think each of the following would be for you:
Rows Not Helpful Somewhat Helpful Very Helpful
Weekly check-in with a counselor
Stress management workshops
Peer support groups
Online self-help tools
Are there any barriers that make it difficult for you to access support at school? (Select all that apply)
Other
What would make it easier for you to ask for support or participate in therapy services?
Is there anything else you would like to share about your support needs?
Should be Empty:

Select theme:

Rows	Not Helpful	Somewhat Helpful	Very Helpful
Weekly check-in with a counselor
Stress management workshops
Peer support groups
Online self-help tools