North Hardin Youth Services Center

Student Survey 2015-2016

I am in 9th 10th 11th 12th Grade. (Please circle one.)

Which of the following do you thinkyou or teens that you personally know need help with? (Check all that apply)

Dealing with divorce in the family

Counseling for teens

Tobacco use

Teen pregnancy

Abuse in the home

Someone to look up to

Self esteem issues

Dealing with the death of a close relative or friend

Girlfriend/boyfriend issues

Dealing with anger

Emergency assistance: food, clothing, school supplies, housing, medical needs

Violence in school

Alcohol use/Drug use

Suicide issues

Diet/exercise

Vision and/or health problems

Friends/Fitting in

English as a Second Language

I am a teen parent/parent-to-be and am interested in the Teens as Parents Program at school

After school or summer enrichment activities

Youth need assistance with planning for the future

 I am confident in my skills to fill out a job application

 I am confident in my skills to fill out a college application

 I am confident in my skills to fill out a resume’

 I am confident in my skills to go on a job interview

What do you think are the top 3 social or emotional issues among teens today?

  1. ______
  1. ______
  1. ______

List the top 3 things you need in order to make good decisions about your future career and/or college plans?

  1. ______
  1. ______
  1. ______

If you have questions or need help with any of these issues, please see your school counselor or your school’s Youth Service Center coordinator, Leslie Hall. The Youth Service Center is located in the hall near the front office and directly across from the Assistant Principal’s Offices. You may also make contact by email at .

The results of this survey will be used in program planning for your school’s Youth Service Center.

Please do not put your name on this survey.