Grade:_____                                                 Student Name: ___________________ Adams Middle School Guidance Department End of the Year Feedback Form Do you know who your Guidance Counselor is? Yes                                             No Do you know any Guidance Counselor? Yes                                             No Did you feel supported or helped by a Guidance counselor in dealing with an academic challenge? Yes                                             No Did you feel supported or helped by a Guidance counselor in dealing with a social or personal challenge? Yes                                             No Check the things your Guidance Counselor can or has helped you with during your time at Adams?   My schedule      Help if I am struggling academically Help if I am struggling emotionally Help if I am in a difficult family situation Help if I am struggling in a class Help if I am struggling a with friend and peers Help if am struggling with a health issue Answering questions from my family/parents about school Exploring my career interests Other:_________________________________________________ Turn Around….. More on back              How strongly do you agree or disagree with the following statement: My Guidance counselor makes time for me if I need help. Circle one Strongly Agree Agree Disagree Strongly Disagree I find it easy to talk to my Guidance Counselor. Circle one Strongly Agree Agree Disagree Strongly Disagree I am satisfied with the level of support I get from my Guidance Counselor. Circle one Strongly Agree Agree Disagree Strongly Disagree I feel supported by my Guidance Counselor when dealing with an academic challenge. Circle one Strongly Agree Agree Disagree Strongly Disagree I believe that my Guidance Counselor can help me deal with personal issues. Circle one Strongly Agree Agree Disagree Strongly Disagree I feel comfortable going to my Guidance Counselor about personal issues that I might be struggling with. Circle one Strongly Agree Agree Disagree Strongly Disagree I feel part of Adams Middle School. Circle one Strongly Agree Agree Disagree Strongly Disagree I have a trusting relationship with at least one adult at school. Circle one Strongly Agree Agree Disagree Strongly Disagree I feel physically safe on campus. Circle one Strongly Agree Agree Disagree Strongly Disagree I would like to talk to my Guidance Counselor about: ____________________________________________________________________________________________________________________________________________________________________________________________________________