This study examined a pilot participatory needs assessment that was conducted with nine senior high school students from Port of Spain, Trinidad. Photovoice was used to engage these students in critical dialogue about their perceptions of issues affecting their health. Trained graduate students facilitated a 3-day training session in photovoice technique/ethics, writing narratives, critical reflection and dialogue with these students. Once trained, they were given disposable cameras and asked to photograph their school environment and document their thoughts on what they had photographed. After collation of photos and dialogue, seven health themes emerged. The most recurring themes included quality of the food served at schools, need for safe, clean and well-maintained school facilities, and role modeling by teachers, parents and community. Recommendations to address the concerns identified were discussed by the participants. The study concluded that conducting needs assessment, which concentrates on the voices of those affected, can be a first step in creating successful and cost-efficient programs and interventions tailored to specific groups. A needs assessment using photovoice should be a technique considered by school staff, government leaders, health professionals, and NGOs.