Small Group Interest Survey at Blended Site

You are invited to participate in a School Counseling department survey about small groups. Small groups allow students to work with peers that are dealing with similar issues to build common ground, support, and learn coping strategies. Please take some time to complete the questionnaire below. We value your feedback.Thank you very much for your time and support. Please start the survey now by clicking on the Continue button below.

* What is your name? (first and last)

* What School do you attend?

AZVA

Insight-ISAZ

* Would you be interested in participating in a small group session held at the Mesa I Learn center about once per week for 5-6 weeks?

YES

MAYBE

* Would you be able to attend the site specifically for a small group even if you do not normally attend at that day or time?

YES

MAYBE

* Please list what time you would be most available on Monday or Tuesday:

Mornings

Afternoons

I am not available to meet on these days

* Please rank your preferences (with 1 being the top choice) of small group topics in order of interest:

	Drag your choices here to rank them
Anger/Stress management Grief and loss Social Skills Divorce and family relationships Academic Success in a virtual environment Teen parenting College and Career Preparation Test Taking skills Other

If you listed "Other" as your top 1-3 choice in the question above please list what topic(s) you are interested in:

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