Group Counseling Survey
I am hoping to run some counseling groups for students ages 5 - 8 years focused on particular student needs. Please complete this survey if you feel your child is struggling in any of the listed areas. Groups will form based on the responses received. This survey does not guarantee that every group will be run and they may have staggered start dates throughout the school year. Groups will consist of weekly meetings of 20 - 30 minutes for 6 - 8 weeks. These sessions do not replace outside counseling and therapeutic supports. If your child is experiencing significant distress, please also seek counseling outside of the school setting. Students make the greatest gains when the challenges can be addressed by including the full family system. Please reach out If you need help identifying outside resources.

This form can be completed electronically or complete a hard copy sent home in backpacks and return to your child’s teacher.

Halina Radosz, School Adjustment Counselor
halina.radosz@gmrsd.org
413-863-7399

NOTE: I am available during school hours 8:30am - 3:30pm, Mon-Fri only. If you or a family member is feeling unsafe or otherwise needs help right away, Crisis Services is available 24/7 at 413-774-5411 or call 911.
Sign in to Google to save your progress. Learn more
Caregiver name *
Caregiver email *
Caregiver phone *
Student name *
Student grade level *
Which group topic do you think your child would benefit from participating in? Select all that apply. *
Required
Please provide pertinent background information regarding the challenges your student is facing as well as child or family strengths. *
Would you like me to call you to discuss your concerns or situation?
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Gill-Montague Regional School District. Report Abuse
Google Forms