JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Pre Survey-School Based Mental Health Video
Kimberley Welk & Associates
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Please provide today's date:
*
MM
/
DD
/
YYYY
Please rate the following statements on a scale of "Not Familiar" to "Extremely Familiar."
I am familiar with school based mental health
*
Not at all
Slightly
Somewhat
Moderate
Extremely
I am familiar with why a student may be in need of school based mental health services.
*
Not at all
Slightly
Somewhat
Moderate
Extremely
I am familiar with the benefits of school based mental health.
*
Not at all
Slightly
Somewhat
Moderate
Extremely
I am familiar with the referral process for my student to receive school based mental health services.
*
Not at all
Slightly
Somewhat
Moderate
Extremely
Submit
Clear form
This form was created inside of Reedsville School District.
Report Abuse
Forms
