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Student ACES Needs Assessment
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School
Are you currently enrolled in school full time? *
- yes
- no
How often do you attend school? *
- I go to school every day
- I miss about 1-2 days a week
- I miss about 3-4 days a week
- I rarely go to school
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Free Time
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Employment
Have you ever had a job? *
- yes
- no
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Relationships
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Family
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Drugs & Alcohol
Have you taken a health class at school? *
- yes
- no
Do you think using drugs is bad?*
- Yes, all drugs are bad
- Eh, some drugs are bad
- No, drugs are good
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Mental Health
Do you think the grown-ups in your life take pretty good care of you? *
- yes
- sometimes
- no
Do you feel safe at home? *
- yes
- sometimes
- no
Do you feel safe at school?*
- yes
- sometimes
- no
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Attitudes
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Social Skills

Your Company Name

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Address

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800-555-0101
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