University of New Orleans

Counseling
& Career Center

for Personal Counseling & Mental Health Concerns

UNO Counseling & Career Center Home

UNO Counseling Services is seeking to evaluate the assess and respond to challenges faced by our campus community. Below is a list of issues/concerns that students may experience. For each concern, please mark to what extent each one has impacted you personally within the last 6 - 12 months.

Note: Your answers are anonymously collected for a database and cannot be linked to any one individual.

Please mark the level of concern you may have with each of the following issues:

	"None"	"Some"	"Much"	"Very Much"	"All the Time"
1. Alcohol/Drugs
2. Anger/Hostility
3. Anxiety/Panic/Worry
4. Body Image
5. Conflict With Employer
6. Conflict With Family
7. Conflict With Friends/Roommate
8. Conflict With Instructor
9. Conflict With Partner/Spouse/Boyfriend/Girlfriend
10. Depression
11. Eating Problems
12. Emotional Abuse
13. Family Problems
14. Financial Problems
15. Grades/Probation
16. Grief/Loss
17. Learning Disability
18. Loneliness/Isolation
19. Major/Career
20. Motivation
21. Physical Abuse/Safety
22. Pregnancy
23. Racial/Ethnic Conflicts
24. Self Esteem
25. Sexual Abuse
26. Sexual Assault/Harassment
27. Sexual Identity
28. Sexuality
29. Shyness
30. Stress
31. Suicidal Thoughts
32. Study Habits
33. Test Taking Anxiety
34. Time Management
35. Unplanned Pregnancy/Termination of Pregnancy
36. To what extent do any of the above concerns affect your grades?
37. To what extent do any of the above concerns affect your decision to remain in school?

38. Would you be inclined to seek help for any of these problems?					Yes	No
39. Please mark any of the following persons you would turn to for help.
Friend		Family Member	Counselor or mental health professional		Pastor/Clergy	Instructor
Prior to this survey were you aware that:
40. The Counseling Services exists?					Yes	No
41. We provide short-term individual counseling for personal, emotional and social concerns?					Yes	No
42. We provide career counseling and testing for undecided students?					Yes	No
43. We provide educational, learning, and personality testing and screenings?					Yes	No
44. We offer a series of workshops and small group sessions each semester on different psychological and educational topics?					Yes	No
Please answer the following about yourself:
45. With whom do you currently reside?
		Parents	Spouse/Significant Other		Roommate/Friend	Alone
46. If you live in student housing, which facility do you live in?
		Bienville Hall	Lafitte Village	Pontchartrain Hall	Privateer Place	N/A
47. What is your academic classification?
		Freshman	Sophomore	Junior	Senior	Grad Student
48. What is your sex/gender?				Male	Female	Transgendered
49. What is your age?
		Under 18	18-22	23-28	29-35	Over 35
50. What is your marital status?
		Married	Divorced	Separated	Single
51. What is your sexual orientation/identity?
		Asexual	Bisexual	Heterosexual	Homosexual	Questioning
52. What is your ethnic/racial/cultural status?
		African-American	Asian	Caucasian	Hispanic
		Biracial	Other (Please Specify)
53. How many hours are you currently enrolled at UNO?
54. Are you employed?
Yes		No	If yes, how many hours per week do you work?
55. What is your total monthly income from employment?
		Less than $400	$400-$625	$626-$850	$851-$1250
		$1251-$1650	$1651-$2100	More than $2100
56. What is your main source of income?
	Self	Parents	Loan	Scholarships/Grants	Partner/Spouse
57. Do you have health insurance?				Yes	No


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