5th - 8th Grade

Orientation Survey

 

Last Name           

First Name          

Student ID           

Grade                  

Homeroom:       

Home School       

 

 

Is this your first visit to the Guidance Center this year? Yes               No

 

 

If you've been here before, how many times have you been here this year?         

 

 

How many days have you been assigned to the Guidance Center on this visit?       

 

 

Why were you sent to the Guidance Center?  

 

      

 

 

Do you think it was your fault?   Yes             No

 

 

What was the choice you made that caused you to be in trouble?

 

 

 

 

Why was it wrong to do what you did?

 

 

 

 

What would you do differently in the future so that you will not get in trouble?

 

 

 
Do you think an assignment to the Guidance Center was an appropriate consequence? Yes                     No

 

If you answered "no", what consequence do you think you should have received?

 

 

 

 

Name an adult from your home campus that can help you stay out of trouble and succeed in school.

 

 

 

 

Over all, how has your year been so far?

 

 

 

 

Name two goals you have for yourself.

 

 

 

 

Are you currently passing all your classes? Yes                  No

 

 

What high school do you plan to attend?

 

 

 

 

What are your plans for life after high school?

 

 

 

 

My biggest problem or issue I'm going through right now is:

 

 

 

 

My life right now is .

 

 

If you could change one thing in your life, what would it be?

 

 

 

 

Which of the following would you like more information on?  

High school credit requirements

College Information

Tutoring

Dealing with my emotions

Drug or Alcohol Abuse Information

Anger Management

Family and Positive Relationships

Career Choices

Study Skills

Other 

 

 

 

I would like to see a counselor Yes, please

  No thanks, not at this time

 

 

One thing I would like for you to know about me is: