Age:
18 and under
19–20
21–24
25–29
30–39
40–49
50 and up
Gender:
Male
Female
Genderqueer, Non-conforming, Non-binary
Transgender
Another Gender Identity
Are you Hispanic or Latino?
Yes
No
Race:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
How many counseling sessions have you attended this year?
1 session
2–5 sessions
6–10 sessions
11 or more sessions
Career Interpretation Day
EPY Instructor Visit Only
What is your main reason for seeking counseling?
Personal (for example: emotional, relationship, stress, family concerns).
Career (for example: career choice, planning for the future, picking a major).
Educational (for example: time management, program requirements, test anxiety).
Academic Advising (for example: picking classes, mandatory enrollment steps).
Rate Each Statement Below:
Rows
Strongly Agree
Agree
Disagree
Strongly Disagree
Not Applicable
Scheduling an appointment was easy.
I was able to get an appointment in an acceptable amount of time.
The reception staff was courteous and helpful.
I felt comfortable in the waiting area.
I received appropriate information about confidentiality and my rights and responsibilities.
I am glad I came for counseling and would come again if needed.
I would refer my friends to the Counseling Center.
I regard the Counseling Center as a necessary part of the college.
Overall I was satisfied with the quality of counseling.
Rate Each Item Below:
Rows
Strongly Agree
Agree
Disagree
Strongly Disagree
Not Applicable
I felt accepted and respected by my counselor.
My counselor understood the concerns I brought to counseling.
The counselor helped me to be comfortable enough to express what I was thinking and/or feeling most of the time.
My counselor helped me to clarify the nature of my concerns.
My counselor worked with me to set goals.
I was encouraged by my counselor to make my own decisions.
My counselor seemed well trained and skilled in helping me.
I am better prepared now to work through future problems on my own.
Counseling has helped me to be more successful in school.
Rate from High to Low:
Rows
5 - High
4
3
2
1 - Low
Your overall level of distress that brought you to counseling.
Your overall level of that same distress at the time you stopped counseling.
How could we improve the Counseling Center?
Other Comments or Suggestions:
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