College Classification:

Age:

Gender:

Male   Female   Other

Ethnicity:

African American
Asian American/Pacific Islander
Latino/Hispanic
European American/Caucasian
Native American
Other

How many counseling sessions have you attended at Earlham?

1 2-10 11-20 20+

Counselor Seen at Earlham College Counseling Services:

For what reason did you come to Earlham College Counseling Services?
(Check as many as apply)

Personal Counseling
Academic Counseling
Career Counseling
LOA/Readmit Counseling
Referrals needed
Other concerns

Please select the number which indicates your level of agreement with each statement (1=least agreement; 5=highest agreement).

1. I was treated courteously by the counselor I saw.
  1   2   3   4   5   N/A

2. The counselor was appropriately concerned about my issues.
  1   2   3   4   5   N/A

3. The counselor seemed well-trained and skilled in helping me with my concerns.
  1   2   3   4   5   N/A

4. I felt comfortable in the waiting room.
  1   2   3   4   5   N/A

5. As a result of counseling, I developed new or better skills for coping with my concerns.
  1   2   3   4   5   N/A

6. I thought there were too many forms to fill out.
  1   2   3   4   5   N/A

7. If the need to speak to someone arises again, I would return to Earlham Counseling Services.
  1   2   3   4   5   N/A

8. I would recommend Earlham Counseling Services to others.
  1   2   3   4   5   N/A

9. The anxiety, depression or other screenings were helpful to me.
  1   2   3   4   5   N/A

10. As a result of counseling, I believe that I am more likely to remain in college.
  Yes   No

11. As a result of counseling, I believe that I will do better academically.
  Yes   No

12. The length of time to schedule an appointment with a counselor was too long.
  Yes   No

13. Other Comments: