McMurry Home >> Student Affairs >> Counseling >> Need for Services Assessment
Need for Services Self Assessment

Please fill out completely. This information will be used to make referrals to the appropriate McMurry office. All information is confidential. Your peer leader will receive confirmation that you completed the assessment but not the results of the survey.


 First Name  Last Name  Maiden Name

 Local Address  City  State  Zip

 E-mail  Local Phone  Peer Leader

Please rank your need for all of the following services according to the following scale:
1-No need; 2-Occasional need; 3-Moderate need; 4-Definite need

 Tutoring
1
2
3
4
     Math/Science
     Writing/English
     Study Skills
     Other, Please specify subject:

 Counseling
1
2
3
4
     Personal Counseling
     Career Counseling
     Disability Services Counseling
     Financial Aid Counseling

 Support Groups
1
2
3
4
     Depression/Anxiety
     Alcohol Use/Abuse
     Self-Esteem
     Eating Disorders
     Dating and Relating
     Survivors of Abuse
     First Generation College

     

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