Counselor Check-In 2020-2021 School Year

Checking in with Mrs. Hill

Hello Belshaw Families,

Welcome back to school! Please complete this short survey requesting a check-in and I will follow up with you! Looking forward to checking in with you! Thank you!

Mrs. Hill

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* 1. Contact Information

Student Name *

Grade

Email Address

Phone Number *

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* 2. How's it going?

Really Struggling

Somewhat Struggling

Okay

Pretty Good

Great

Really Struggling

Somewhat Struggling

Okay

Pretty Good

Great

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* 3. The hardest thing about this upcoming school year is...

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* 4. Something I am looking forward to this upcoming school year is...

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* 5. I can really use help with...

Emotional/Mental health support for my child/family

Resources such as food, internet, housing and/or school supplies

Distance learning

Other (please specify)

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* 6. Please contact me

Before 12 P.M.

After 12 P.M.

Other