Orangeburg-Calhoun Technical College-SSS-Needs Assessment Form

TRIO SSS NEEDS ASSESSMENT

Please check all the following SSS services and activities that you need or would be interested in receiving this year:

Student Name *

First Name Last Name

Student Email *

example@example.com

TRIO SSS Counselor

Patricia Nicholas Nicole Simpson

How can Student Support Services help you? (Check as many as apply)

Are there any specialized needs or services (medical, etc.) of which the program should be aware?

Entry date at OCTECH

mm-dd-yyyy

Number of course hours completed

Cumulative GPA

GOAL PLANNING

Please help us reduce your risk factors while we help build your resiliency. Think of your positive attributes when you set these goals. They include academic, career, educational plans, as well as time and stress management for you and your family.

1. Short-term goal (one month)

2. Medium goal (this semester)

3. Long-term goal (one year)

STUDY SKILLS

1. How much time do you devote to studying each day?

2. Where do you usually sit in the classroom?

3. What note-taking method do you use? (Ex: outlining, charts, main concepts, etc.)

4. Do you use a time management tool such as a daily/weekly planner?

Yes No

5. When you do not understand something in class, what do you do?

6. Where do you study?

7. How many absences have you had this semester?

8. Are you having trouble in a particular course(s)?

Yes No

If "yes," which course(s):

9. Are you considering transferring to a four-year school?

Yes No

If “yes,” please list your transfer choices:

Student Signature

Clear

Date Signed

mm-dd-yyyy