Counselor Check-In
I miss seeing all of my DCAC students each day! Please let me know how you are doing!

 This form is not mandatory or required, so no pressure! I want to know how you are doing, and that means how you are REALLY doing.  When you fill this out, only Ms. Young will know who is writing, and any comments are anonymous. We miss you all and hope to see you soon. Stay in touch!


*** Remember what you say stays between us unless you want to hurt yourself or someone else, or if someone else is hurting you. Anything else stays between us!
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Email *
First and Last Name *
Grade Level *
How are you feeling this week? *
How is your sleeping? (1= Didn't sleep well at all; 5= Best sleep ever.) *
How is you eating? (1= Not very healthy eating; 5= Eating.) *
Exercising? (1=I'm sitting all day, not doing much for my physical well-being; 5= I feel great- getting plenty of sun and movement.) *
What has not been great this week? *
What has gone well this week? *
If you wish for your counselor to contact you, please list the details below (example: email address, phone number, etc. you wish to be reached by and best day and time. *
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