Needs Assessment Survey
Student's Full Name:
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Today's Date:
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Month
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Day
Year
Date
School
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FCC
LTC
OCC
WVC
Please check any of the following items which describe you:
Out of school too long
My family does not understand college demands
Afraid of failing in college
Unsure of college procedures
Difficulty finding childcare
Difficulty participating in discussions
Afraid I might not fit in at my college
Little or no experience on the Internet
Difficulty meeting new people
Difficulty managing money
Panic during tests
Difficulty meeting deadlines
Few computer skills
May need personal counseling
What obstacle(s) would most likely prevent you from completing your academic goals? (Check all that apply):
Poor study habits
Poor time management skills
Balancing academics and extracurricular activities
Poor Note taking skills
Bad grades
Family medical problems
Lack of money
Take things too seriously
Separation or divorce
Taking the wrong classes
Problems at home
Personal support/encouragement
Always feeling tired
Trouble sleeping
Easily distracted
Recurring health concerns
Afraid to speak up in class
Too shy
Alcohol and/or drug problems
Feeling depressed or sad
Always worrying
No support from family/friends
Dealing with bills
Test anxiety
Difficulty in one or more of the following academic areas:
Math
Reading
English
Science
What other areas with which you need assistance with?
Financial:
Personal budget
FAFSA
Grants/Scholarships
Loans
Personal Issues:
Stress Management
Substance Abuse
Relationships
Anxiety
Depression
Motivation
Exploring Diversity
Goal/Decision Making
Transfer:
Selecting Transfer School
Applications
Search Process
Funding
Planning
Career:
Choosing a Career
Interviewing
Resume/Cover Letter
Job Searching
Co-op/Internship
Leadership Development
Short Term Goals (This semester):
Long Term Goals (This academic year):
How would you describe yourself?:
Explain why you selected your major and/or career field. (OR If you are undecided) What are your biggest strengths?:
Why do you think you should be considered for the SSS program?:
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