Canisius College

This is a confidential questionnaire to help the Counseling Center improve the quality of its services. Whether or not you have accessed services at the Counseling Center, your input-feedback is important to us. We appreciate your assistance in completing this survey.

1. I am a

male

female

2. What is your academic status?

3. What interactions have you had with the Canisius Counseling Center?

4. What do you see as strengths of the Counseling Center?

5. Weaknesses or areas of improvement?

6. The Counseling Center would be more helpful for me if:

7. What services would you like to see provided by the Counseling Center?

8. Please mark the level of concern you have with each of the following topics:

	No Concern	Slight Concern	Concern	High Concern	Extreme Concern
Loneliness/Isolation
Family Problems
Alcohol/Drugs
Abortion
Anger/Hostility
Anxiety/Panic/Worry
Eating Problems (too much/too little)
Financial Problems
Grief/Loss
Physical Abuse/Safety
Pregnancy
Self Esteem
Sexual Abuse
Sexual Assault/Harassment
Sexual Identity
Sexuality
Body Image
Shyness
Spirituality
Stress
Suicidal Thoughts
Conflicts with others
Verbal/Emotional Abuse
Racial/Ethnic Conflicts
Academics/Grades
Learning Disability
Major/Career Choice
Motivation
Study Habits
Test Anxiety
Time Management
Relationship Problems

Prior to this survey, were you aware that:

9. The Counseling Center exists?

yes

10. Where the Counseling Center is located?

yes

Thank you for your participation in this survey. The information you provide is very helpful in evaluating our department. Please feel free to conact us at 888-2620 with any questions or concerns.