School Based Counseling Program

Faculty & Administrator Survey
School Year
School Campus
Please check if you are:
Student Name
Name or Identifier
Grade of Student:
1. Based on the data you've collected, the student has made academic progress since receiving counseling as a related service.
2. Based on the data you've collected, the student has made behavioral/social progress since receiving counseling as a related service.
3. Based on the data you've collected, has the student progressed in obtaining his/her IEP goals?
4. Do you feel this student would be as successful in school without counseling services?
5. Any other feedback or comments regarding counseling support services?
Total of 1-4 questions (Higher Score = better; Highest score = 16):
Should be Empty:

Faculty & Administrator Survey