Examining self-reported problems of students receiving school mental health (SMH) services holds promise for informing strategies across all tiers of school support. However, no prior research has investigated students' self-reported needs. The current study coded open-ended youth problem statements (N = 1212) from a diverse sample of 455 students (37.4% white) receiving SMH services in 52 high schools across three states. Problem statements were coded against 120 items of the Child Behavior Checklist (CBCL, Achenbach & Rescorla, 2001) and 24 additional problem domains not found in the CBCL. Most frequently cited problems were poor schoolwork (n = 190, 43.0% of all students), family problems (n = 90, 20.4%), and anxiety (n = 89, 20.1%). Thirty-three percent of students identified problems that loaded on the CBCL internalizing scale only, 24.0% identified problems from the externalizing scale only, 19.5% identified both internalizing and externalizing problems, and 21.3% of youth-identified problems did not fit either scale. Exploration of differences by race/ethnicity found Latinx students were significantly more likely to report problems in school, White and Latinx students more likely to report internalizing problems, and Black students more likely to report problems coded to the externalizing scale. However, item-level analysis showed this difference was driven by a small number of specific items that may represent teacher bias in referrals, cultural differences in expression of problems, and/or limitations of the CBCL coding system. Results suggest SMH strategies are needed that address academic and family problems and that are responsive to needs of youth from diverse backgrounds.