JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Checking in with Mrs. Hinton
Hello!
Please fill out the form and I'll get back with you as soon as I can!
Thanks,
Mrs. Hinton
khinton@bcbe.org
Sign in to Google
to save your progress.
Learn more
* Indicates required question
What is your first name?
*
Your answer
What is your last name?
*
Your answer
What grade are you in?
*
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Required
What is your teachers name?
Your answer
How are you feeling?
*
Happy
Sad
Confused
Stressed
Angry/Aggitated
Anxious/Nervous
Other
Required
What calm down skill did you try?
Take deep breaths
Draw a picture
Count to 10
Listen to music
Dance
Exercise (jumping jacks, push ups, jog in place, etc.)
Read a book
Color a picture
Relax
After using that skill, how do you feel?
Not better at all
1
2
3
4
5
So much better!
Clear selection
What would be helpful for you right now?
*
Individual Counselor Check-Ins
I need a quick idea on how to handle my stress
I need a quick idea on how to solve a problem
Other:
Required
Add your contact information if you would like me to follow-up with you. (Email, phone number), but please ask your parents first!
*
Your answer
In the meantime you can try.....
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Baldwin County Schools.
Report Abuse
Forms
