Counselor Check-In (2020-2021)

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Kimball Families: This is a very difficult time for many of us. This form is a way to check in with me so that I can offer support, if needed. Please complete this form to let me know how you are doing. I will follow up with you, if requested.
Here for you,
Ms. Amy Fernandez
School Counselor
Kimball Elementary

Student's name (First and Last) & EMAIL *

Student's grade *

My child could really use some support with: *

Social development (social awareness, relationship skills, communication skills, etc.)

Emotional development (self-awareness, self-management, feelings, coping skills, etc.)

Academic development (academic self-concept, time-management, goal setting, etc.)

Other:

I, as a parent/guardian, could use support with: *

Community resources/information

Parent class/Parenting skills support

Scheduling a meeting with Ms. Fernandez, the school counselor

I don't need any support at this time

Other:

I would like the counselor to contact me. If yes, please indicate the best time and way to reach you (check "Other" and include the best day/time/phone number or email). *

Yes

Other:

Submit

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