North-Grand High School Needs Assessment

1- What year are you in school?

o Freshman
o Sophomore
o Junior
o Senior

2- What is your gender?
o Male
o Female
o I choose not to disclose

3. How do you describe your race/ethnicity? (Choose all that apply)
o American Indian or Alaska Native
o Hawaiian or Other Pacific Islander
o Asian or Asian American
o Black or African American
o Hispanic or Latino
o Non-Hispanic/White
o Other ___________________________

4. What is your age?
o 14-15
o 16-17
o 18-19
o 20+

5. What is your preferred language to speak in?
o English
o Spanish
o Other ___________________________

6. Please choose who lives in your household. (Select all that apply)
o Mother
o Father
o Step-Mother
o Step-Father
o Siblings (Full, Half, Step)
o Grandmother
o Grandfather
o Uncle
o Aunt
o Cousins
o Son/Daughter
o Other___________________________
7. I like coming to school.
o Strongly Agree
o Agree
o Neither Agree nor Disagree
o Disagree
o Strongly Disagree

8. I feel comfortable going to my counselor about my SCHOOL concerns.
o Strongly Agree
o Agree
o Neither Agree nor Disagree
o Disagree
o Strongly Disagree

9. I Feel comfortable going to my counselor about my PERSONAL concerns.
o Strongly Agree
o Agree
o Neither Agree nor Disagree
o Disagree
o Strongly Disagree

10. There is at least one staff member in the school who I believe truly cares about me and
my success.
o Strongly Agree
o Agree
o Neither Agree nor Disagree
o Disagree
o Strongly Disagree

11. I feel rejected, or like I dont belong, when I am at school.
Strongly Agree
o Agree
o Neither Agree nor Disagree
o Disagree
o Strongly Disagree

12. I get along with most people at school.
o Strongly Agree
o Agree
o Neither Agree nor Disagree
o Disagree
o Strongly Disagree




13. I believe my relationships with my peers are healthy relationships.
o Strongly Agree
o Agree
o Neither Agree nor Disagree
o Disagree
o Strongly Disagree

14. I feel that my thoughts, opinions, and values are respected in all of my relationships
(friends, significant others, etc.)
o Always
o Often
o Sometimes
o Rarely
o Never

15. My relationships with my friends and/or significant other bring me joy.
o Always
o Often
o Sometimes
o Rarely
o Never

16. When I am having issues with my friends and/or significant other, we communicate to
work things out.
o Always
o Often
o Sometimes
o Rarely
o Never

17. When I am having issues with my friends and/or significant other, we yell and scream
at each other.
o Always
o Often
o Sometimes
o Rarely
o Never

18. When I am having issues with my friends and/or significant other, we usually resort to
physical aggression.
o Always
o Often
o Sometimes
o Rarely
o Never

19. I feel comfortable around my friends and/or significant other.
o Always
o Often
o Sometimes
o Rarely
o Never

20. I would like to learn more about healthy communication.
o Strongly Agree
o Agree
o Neither Agree nor Disagree
o Disagree
o Strongly Disagree

21. I would like to learn more about how to resolve conflict.
o Strongly Agree
o Agree
o Neither Agree nor Disagree
o Disagree
o Strongly Disagree

22. I would like to learn more about what relational abuse is (physical, verbal, emotional)
and what my options/resources are.
o Strongly Agree
o Agree
o Neither Agree nor Disagree
o Disagree
o Strongly Disagree

23. I am concerned that one or more of my relationships may not be a healthy relationship.
o Strongly Agree
o Agree
o Neither Agree nor Disagree
o Disagree
o Strongly Disagree

24. Please feel free to utilize this space to offer suggestions, ask questions, and express
concerns to your counselors.





*Note: The assessment was administered using Qualtrics. A link was provided for the
students to take the assessment on the computer. Seeing as the survey link has closed, we
have typed the assessment in this format.