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NEEDS ASSESSMENT SURVEY

Listed below are various concerns of college students. Review the items and place a check mark next to each item of concern to you. If an item is not listed, then write it in next to Other in the space designated.

Thank you for taking the time to complete this survey.

FAMILY/RELATIONSHIPS

Parenting
Dating (Finding the right person, Breaking Up)
Marital Problems
Abuse(Spousal, Child)
Sex Education (AIDS awareness, STDs)
Divorce/Separation
Co-Dependency(living with an addicted family member)
Other

FINANCIAL/ACADEMIC

Financial Planning
Study Skills (Time Management)
(Financing School, Getting out of debt)
Anxiety(Math, Test, Public Speaking)
Other

PERSONAL/CAREER

Self esteem
Choosing a major
Interpersonal skills training (Assertiveness)
Choosing a career
Depression
Anxiety (Stress)
Drug Abuse (Alcoholism, Drug Addiction)
Health (Dieting, Exercise)

Other

Would you be interested in attending a seminar or joining a group on one of these topics?

YES
NO

If yes, then what time of day would be most convenient for you?

MORNING
NOON
AFTERNOON
EVENING


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2500 Walton Way Augusta GA 30904 706-737-1471
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