UNO Counseling and Career Center: Counseling Services Needs Assessment Survey

	UNO Counseling and Career Center counseling services is seeking to evaluate, assess and respond to challenges faced by our campus community. For each of the following concerns, please mark to what extent each one has impacted you personally within the last 6 - 12 months. Please Note: Your answers are anonymously collected in a database and cannot be linked to any one individual.

1.	Alcohol/Drugs*
	None  Some  Much  Very Much  All the Time

2.	Anger/Hostility*
	None  Some  Much  Very Much  All the Time

3.	Anxiety/Panic/Worry*
	None  Some  Much  Very Much  All the Time

4.	Body Image*
	None  Some  Much  Very Much  All the Time

5.	Conflict with Employer*
	None  Some  Much  Very Much  All the Time

6.	Conflict with Family*
	None  Some  Much  Very Much  All the Time

7.	Conflict with Friend(s)/Roommate(s)*
	None  Some  Much  Very Much  All the Time

8.	Conflict with Instructor*
	None  Some  Much  Very Much  All the Time

9.	Conflict with Partner/Spouse/Significant Other*
	None  Some  Much  Very Much  All the Time

10.	Depression*
	None  Some  Much  Very Much  All the Time

11.	Eating Problems*
	None  Some  Much  Very Much  All the Time

12.	Emotional Abuse*
	None  Some  Much  Very Much  All the Time

13.	Family Problems*
	None  Some  Much  Very Much  All the Time

14.	Financial Problems*
	None  Some  Much  Very Much  All the Time

15.	Grades/Probation*
	None  Some  Much  Very Much  All the Time

16.	Grief/Loss*
	None  Some  Much  Very Much  All the Time

17.	Learning Disability*
	None  Some  Much  Very Much  All the Time

18.	Loneliness/Isolation*
	None  Some  Much  Very Much  All the Time

19.	Major/Career*
	None  Some  Much  Very Much  All the Time

20.	Motivation*
	None  Some  Much  Very Much  All the Time

21.	Physical Abuse/Safety*
	None  Some  Much  Very Much  All the Time

22.	Racial/Ethnic Conflicts*
	None  Some  Much  Very Much  All the Time

23.	Self-Esteem*
	None  Some  Much  Very Much  All the Time

24.	Sexual Abuse*
	None  Some  Much  Very Much  All the Time

25.	Sexual/Gender Identity*
	None  Some  Much  Very Much  All the Time

26.	Sexuality*
	None  Some  Much  Very Much  All the Time

27.	Shyness*
	None  Some  Much  Very Much  All the Time

28.	Stress*
	None  Some  Much  Very Much  All the Time

29.	Suicidal Thoughts*
	None  Some  Much  Very Much  All the Time

30.	Study Habits*
	None  Some  Much  Very Much  All the Time

31.	Test-Taking Anxiety*
	None  Some  Much  Very Much  All the Time

32.	Time Management*
	None  Some  Much  Very Much  All the Time

33.	Unplanned Pregnancy/Termination of Pregnancy*
	None  Some  Much  Very Much  All the Time

34.	To what extent have any of the above concerns affected your grades?*
	None  Some  Much  Very Much  All the Time

35.	To what extent have any of the above concerns influenced your decision to remain in school?*
	None  Some  Much  Very Much  All the Time

36.	Would you be inclined to seek help for these problems?*
	Yes No

37.	Please indicate to which of the following persons you would turn for help. * (Select all that apply.)
	Friend    Family Member    Spouse/Romantic Partner    Counselor/Mental Health Professional    Pastor/Clergy    Instructor    Other, please specify

	Prior to taking this survey were you aware that:

38.	Counseling services were available on campus to UNO students?*
	Yes No

39.	The UNO Counseling and Career Center provides short-term individual counseling for personal, emotional and/or social concerns?*
	Yes No

40.	The UNO Counseling and Career Center offers career testing/counseling for undecided students?*
	Yes No

41.	The UNO Counseling and Career Center offers educational, learning, and personality testing and screening?*
	Yes No

42.	The UNO Counseling and Career Center offers workshops and small group sessions each semester on different psychological, educational and career topics? *
	Yes No

	Please answer the following about yourself:

43.	With whom do you currently reside?*
	Parent(s) Spouse/Significant Other Roommate/Friend Alone Other, please specify

44.	If you live in student housing/on campus, in which facility do you live?*
	Pontchartrain Hall Privateer Place I do not live in student housing/on campus.

45.	What is your academic classification?*
	Freshman Sophomore Junior Senior Graduate Student Other, please specify

46.	What is your sex/gender?*
	Male Female Transgendered Other, please specify

47.	What is your age?*
	Under 18 18-22 23-28 29-35 Over 35

48.	What is your relationship status?*
	Single/Never Married In a Relationship or Partnered but Not Married Married Separated Divorced

49.	What is your sexual orientation/identity?*
	Asexual Bisexual Heterosexual Homosexual Questioning Other, please specify

50.	What is your ethnic/racial/cultural identity?*
	African-American Asian Caucasian Hispanic Native American Biracial Other, please specify

51.	How many course hours are you currently carrying at UNO?*

52.	Are you currently employed?*
	Yes No

53.	If you are employed, how many hours do you typically work per week?* (Enter "N/A" if you are currently unemployed.)

54.	What is your total monthly income from employment?*
	I am currently unemployed. Less than $400.00 $400.00 - $625.00 $626.00 - $850.00 $851.00 - $1250.00 $1251.00 - $1650.00 $1651.00 - $2100.00 More than $2100.00

55.	What/who is your primary source of income?*
	Self/Job Parent(s)/Family Loan(s) Scholarship(s)/Grant(s) Partner/Spouse Other, please specify

56.	Do you have health insurance?*
	Yes No