Parent Support Survey

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Hello! My name is, Alicia Klinker, and I am the counselor at Patriot. I am collecting some information on what groups would be beneficial for your students to participate in throughout the year and ask that you please fill out the form below. Please only select two groups total in case your first choice is full. If you have more than one student enrolled, please fill out a separate one for each. Groups run 6-8 weeks with one session a week and will rotate throughout the year. Groups will be much smaller this year due to COVID so if you do not feel they need to participate, please do not fill out the group portion. Thank you so much and please feel free to contact me with additional questions or concerns! 719-382-1460 aklinker@ffc8.org

Child name *

Grade *

Kinder

1st

2nd

3rd

4th

5th

What kind of groups would be helpful for your student? Please only pick your top two if you wish for your child to participate in group.

Calm & Cool–A mindfulness group for children who want to learn to focus better, control their anger, and practice and improve conflict resolution skills.

Making and Keeping Friends – For children who want to work on friendship skills and develop effective communication with peers.

Changing Families– For children whose families are going through change. This may be due to separation, divorce, remarriage or adjusting to step-siblings or a blended family.

Grief – For children who have experienced a recent death in the family and need help coping with grief and loss.

Worry Bugs– Kids learn strategies to overcome anxiety.

Has your child's learning been significantly impacted by any of the following in the past year?

Social Conflict

Peer pressure

Distraction from peers in class

Trouble at home

Bullying (When someone says or does something intentionally hurtful and they keep doing it-even when told to stop or shown that their upset)

Death of a family member

Anger/Frustration

Worry/anxiety

Any additional things your child might need support with?

Anything else you would like the mental health team to know?

Would you be willing to allow your child to participate in group? You will receive a permission slip in weeks leading up to group if your child is placed in one. Groups will be smaller this year due to COVID. *

Yes

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