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Perry CSD Mental Health Survey
The District's Counselors/Social Worker have constructed the following survey to monitor students' mental health during this time. Parents/guardians of UPK - 6 students may complete the survey. Students in grades 7 - 12 may complete the survey.
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Email
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Your email
Overall, how would you rate your student's/your mental health?
Excellent
Good
Fair
Poor
Clear selection
During the past two (2) weeks, how often has/have your student/you felt sad, depressed, and/or anxious?
Extremely often
Very often
Somewhat often
Not often
Never
Clear selection
In the past two (2) weeks, has/have your student/you experienced any of the following?
Crying
Increased Sleeping
Decreased Sleeping
Increased Appetite
Decreased Appetite
Withdrawn
Unexplained physical symptoms (Headache, stomach ache)
Difficulty adjusting to change
Thoughts of harming self or others
Other:
During the past two (2) weeks, how often has your student's/your mental health interfered his/her/your ability to get work done, accomplish tasks, and/or get a good night's rest?
Extremely often
Very often
Somewhat often
Not often
Never
Clear selection
Are you interested in a check-in from a counselor/social worker
Yes
No
Clear selection
If interested, please provide the name of the student.
Your answer
If interested, please provide the best method to check-in.
Google Hangout
Phone
Clear selection
If interested, please indicate your counselor/social worker preference. You may select more than one individual.
Miss Ayers
Mrs. Kettle
Mrs. Gaffney-Eaton
Mrs. Ellis
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