STUDENT NEEDS ASSESSMENT SURVEY

DIRECTIONS: Please check the box which best describes your needs as a student.

I feel this is
Area VERY IMPORTANT NOT
Important Important

1. KNOWING MY SELF
1.1 To identify my strengths and abilities.
1.2 To develop more confidence inmy self.
1.3 To understand my personal values.
1.4 To know how to stay in shape.
1.5 To understand my achievement and ability test scores bette
1.6 To know how to handle things that worry me.
1.7 To learn more about grooming and personal care.
1.8 To accept my own views as OK.
1.9 To get over my shyness.
1.10 To understand the way I learn best.
2. GETTING ALONG WITH OTHERS
2.1 To be able to get along better with teachers.
2.2 To be able to get along better with other student.
2.3 To know how to work with my adviser/ counselor.
2.4 To able to get along better with my parents.
2.5 To be able to get along better with my brothers and sisters.
2.6 To learn how to make more friends of my own gender.
2.7 To learn how to make more friends of the other gender.
2.8 To understand more about love and sex.
2.9 To learn more about marriage and family living.
2.10 To understand the changing roles of men and women in tod
society.
2.11 To gain better understanding of people of different races an
cultural backgrounds.
2.12 To know about places in my school and community where I
can get help with my problems.
2.13 To understand the needs of elderly people.
2.14 To accept people who feel or think differently form me.
2.15 To have someone listen to me when I have problems.
2.16 To be able to tell others how I feel.

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 Republic of the Philippines
Department of Education
Caraga Administrative Region
Division of Agusan del Norte
TUBAY DISTRICT II
DONA ROSARIO NATIONAL HIGH SCHOOL

Name:_________________________________Grade/Section.: __________________

Instructions:Check the following code to indicate the extent to which it is important

to you that the Guidance Office does something to respond to the specific need.

NIA - Not Important at All VI - Very Important

SI - Somewhat Important EI - Extermely Important
MI - Moderately Important

AREAS OF CONCERN NIA SI MI VI EI

A. SELF-DEVELOPMENT
1. Know and understand my self better
2. Get rid of my fears
3. Manage my time
4. Plan my life
5. Develop self-confidence
6. Discovery my talents and develop them
7. Improve my appearance
8. Learn more about the world outside
9. Get rid of personal vices/uncomtrollable habits
(drugs, alcohol, stealing, violence, smoking, sex,
gambling, computer addiction) (pls. underline)
10. Others (pls. specify) _________________________________

B. FAMILY RELATIONSHIPS NIA SI MI VI EI

1. Improve my relationship with my siblings
2. Manage siblings in a parentless home
3. Develop the ability to discuss problems with parents
4. Balance between warring/separated parents
5. Teach parents how to handle their children effectively
6. Help parents manage stress/marital problems(pls. underline)
7. Live with relatives
8. Cope with the expectations/demands of parents
9. Relate with a stepparents/step siblings (pls. underline)
10. Others (pls. specify) ________________________________

C. SOCIAL RELATIONSHIPS NIA SI MI VI EI

1. Develop skills for starting/maintaining freindships
2. Make myself attractive to others
3. Develop the ability to avoid being taken advantage of
4. Know how to choose friends
5. Get rid of fear of social situations
6. Settle quarrels with/among friends
7. Handle boy-girl relationships
8. Handle peer pressure
9. Deal effectively with bullies
10. Others (pls. specify)

D. STUDIES NIA SI MI VI EI
1. Understand my lessons
2. Find time to finish assignments and socialize
3. Develop confidence in recitations and discussions
4. Talk to teacher about difficulty in understanding lessons
5. Balance between work at home and studies
6. Work with classmates on projects
7. Cope with financial demands of subjects
8. Develop professionalism among teachers
9. Improve teaching effectiveness of teachers
10. Others (pls. specify) _________________________________

F. SPECIFIC SOCIAL ISSUES NIA SI MI VI EI

1. Learn more about physical abuse
2. Learn more about sexual abuse/harassment
3. Learn more about emotional and verbal abuse
4. Handle experience of abuse (physical, sexual, emotional, verbal)
5. Handle alcoholic/or drug-dependent family member
6. Handle effects of disaster/crisis/calamities
7. Cope with losses (separation, abandoment,death, overseas work)
8. Deal with parents' extramarital affairs
9. Handle adjustments caused by financial crises
10. Others (pls. specify) _________________________________

Please feel free to write down any additional needs or concerns that you wish the
Guidance Office would address.
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