Redesigning School Counseling

Primary Grades Student Survey and Tally Sheet


  1. Before starting the survey:
    1. Check the appropriate grade level below
    2. Enter the total number of students participating in the survey below.
  2. Explain to students that you are going to read a few statements and ask them if the answer is yes or no. If the answer is yes, they should raise their hands. Ask them to be completely honest about how they feel.
  3. Ask the students to put their heads on their desks so they cannot see other students as they respond.
  4. Read each question to the students. After each question say, “If the answer is yes, raise your hand."
  5. Count the number of raised hands.
  6. Record your counts below.

Please contact a member of the Redesigning School Counseling Steering Team at your school if you need help or have questions.

First Grade Second Grade
Total Number of
Students Surveyed

Survey Questions


1.Did you create or update a FUTURE PLAN this year? A FUTURE PLAN includes some of your best school work and how you will improve as a student. It is sometimes called a Graduation Plan or Student Success Plan.  
2.Did you help one of your friends this year?  
3.Did you play on a sports team or attend club meetings this year?  
4.Do you plan to go to college?  
5.Did you do your best at school this year?  
6.Did you read outside of school just for fun this year?  
7.Did you go to work with an adult this year to learn about their job?  
8.Do you know what a college is?  
9.Do you know why it's important to read outside of school?  
10.Do you know how it helps students to participate in sports or clubs?  
11.Do you know how to start a conversation with your parents about school?  
12.Do you know how to help a friend who is in trouble?