Kimme WRAP Student Info Form
In order to help you have a positive transition to Kimme WRAP and receive the support that you need to be successful, please take a few minutes to complete this form. This information will be for staff only.
Student First and Last Name *
Pronouns you want staff to use when referring to you *
Preferred name to be called at school *
Preferred name to be used when staff calls home *
College and Career Readiness Support
These responses will be used to help get you ready for the next steps after high school.
My goal in coming to Kimme WRAP is to *
Required
After high school, I plan on *
Required
To help me be successful at Kimme WRAP, I need *
Required
Mental Health Needs We Should Know
This information will be kept confidential between administration, mental health clinician, and counselor
Do you have a diagnosed condition we should know about? If so, what is it? *
Are you currently taking medication for your condition? *
Have you been hospitalized before due to mental health condition? *
What, if any, outside therapeutic support do you receive? *
One Last Question
Is there anything that you would like your teachers to know about you? *
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