Student Check-in
From Miss Amber, School Social Worker
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We are checking in with you because we care!  While results will be kept confidential (private), we will follow up with individuals if you indicate you need additional support, information or resources during this unexpected situation. In order for us to be able to follow up, please include your name and email and/or the best way to reach you.
Adults, please ask you child/children these questions (paraphrasing as needed) and submit their responses. You can complete one per family if everyone is adjusting similarly, or you can submit one per child if their experiences are different. A social worker or another caring staff member will respond to individual families reporting a need.
Name
Preferred Email and/or phone number
How are you feeling at the time of this survey?
Feeling very down
Doing great!
Clear selection
How are you handling the break from your normal daily schedule?
Uneasy/Anxious
Making it work!
Clear selection
Are you still connecting regularly with friends or family?
Clear selection
How anxious do you feel at the time of this survey?
Not Anxious
Extremely Anxious
Clear selection
Have you felt unsafe during the school closure?
Clear selection
If yes, please explain
Have you been hungry during the school closure because there isn't enough food in the house?
Clear selection
Is your family in need of any supplies, including food, water, clothes, heat, etc?
(This information is confidential. Please list anything you may need.)
Are you worried about any of your family members during this time?
Clear selection
If yes, please explain
Are you worried about any of your friends?
Clear selection
If yes, please explain
What activities have you been doing to remain active?
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