Lakewood Elementary

Hello, I am Mrs. Savinon your school counselor, and I would like to know what you think about our guidance program. Please take a couple minutes to answer the questions below. You can come to see me any time you need help.

Your Grade 6

Directions:Think about your past year(s) at Lakewood. Then, read each question below. Put an X in the box that best answers each question. If you are not sure, then put an X in the “not sure” box.

Question / Yes / No / Not Sure
1. I know what to do when I need to see the counselor
2. I feel safe at school
3. I have friends at school
4. I like doing my school work
5. I have an adult to talk to when I have a problem
6. I like to use the Internet
7. I have met new people on the Internet
8. I like to show my school work to my family
9. I feel safe at home
10. I would like to be in a counseling group this year (please circle which groups you would like to try), Banana Splitz (divorce), Salvaging Sisterhood (girls friendship), Good Grief (dealing with the loss of someone you cared about), Red Hotz (handling your feelings such as anger or worry), Movers and Shakers (moved here from another school), or TheGutzy Group (self-confidence)

Directions: Please answer the questions below.

1. Did you like anything that the counselor did last year or the years before?______

2. What was done that you really liked?______

______

3. Is there anything that was done that you did not like? What were some of these things? ______

______

4. What were some of the things that you learned when the counselor came to your classroom for guidance activities?______

5. What would you like me to add to our counseling program this year? ______

______

6. What groups would you like to participate in this year? (The groups arelisted in question 10) ______

______

7. Do you have any concerns at school or home? ______

______

8. Would you like to know more about Internet safety? ______

9. How can I help you get ready for middle school? ______

______

Please give this form back to your teacher when you are done. Your teacher will not read your answers.

Please come to see me if you ever need to talk.

Teachers,pleasereturn these forms to my box or to my office.

Thank You,

Mrs. Savinon