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Office of Academic Support & Intercultural Services

Opportunities

Coach Program

Initial Assessment Survey

 

Date
Name
NU I.D.#
Email
Local Address
Local Phone
Current Major
Academic Advisor
Number of hours registered for this semester
Do you plan on working this semester?
Do you know where?
Number of hours working per week
 
What are some of your interests?
 
What are your goals for the year?
   
Please mark which of the following University of Nebraska–Lincoln departments you would like more information.
Counseling and Psychological Services (CAPS) Student Opportunities and Services
NU Connections Success Lab Services for Students with Disabilities
Math Lab S.T.A.R. Center
Writing Center University Health Center
Career Services  

 

Check column that best describes your experience last semester:

  No Problem Somewhat of a Problem Considerable Problem
Balancing study time with social time
Attending classes
Handling outside pressure and stress
Taking exams and/or test anxiety
Writing themes and papers
Reading and understanding assignments
Finding support from family and friends
Using alcohol or drugs
Feeling depressed when things start going wrong
Realization of the impact of a previous traumatic event (Post-Traumatic Stress Syndrome)
Not knowing about career possibilities in my field
Concentrating on schoolwork
Forming satisfying relationships with others
Freely volunteering information or opinions in class
Accepting constructive criticism
Feeling life is often uninteresting and boring
Choosing a major
Worrying about health and physical problems
Relationship with parents
Relationships with faculty
Relationship with roommates
Employment affecting school performance
Financial arrangements for school
Procrastination
Feelings of being the "only student of color" in your classes
Feelings of discrimination
Feelings of loneliness
Balancing work and school