Request for Social Emotional Check-In
The Social Emotional Learning (SEL) team at Dixon Road wants to support DRES' students. This form is a way DRES families and staff to request a brief check-in for students who may need some additional support in a social emotional learning area (i.e. coping strategies, conflict resolution, organizational skills, etc.). The SEL team will maintain all legal and ethical parameters regarding student confidentiality while utilizing an electronic platform, such as e-mail and Google Meets to make contact with the student.
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Email *
Student's First Name *
Student's Last Name *
Grade Level
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Student's Teacher's Last Name
Parent/Guardian/Caregiver's Name *
Parent/Guardian/Caregiver's contact information (please include best contact method and time of day to reach you). *
Brief description of social-emotional learning (SEL) concern. *
By submitting my electronic signature, I give permission for an SEL team member (usually the school counselor) to schedule a brief check-in using a Google Meet with my student. I also recognize that this is not long-term therapeutic counseling, but a supplemental social-emotional support for the student. *
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