FMS Family Wellness Check-In

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The well-being of our students and families is our top priority. We know personal and professional situations are changing daily. We are sending this brief check-in to see how our students and families are doing and to provide support, if needed. Please do not hesitate to reach out if you would like to talk about your situation or need additional support.

Email *

Student's Name (If you have more than 1 child in the building, please fill out form for each child) *

School Name * *

Fruitport Middle School

My child is learning via *

All virtual (every day learning at home)

Hybrid (some days at home and some days at school)

What is the stress level in your home right now? *

5: We are doing great! Stress is low.

4: Pretty good, nothing we can't handle.

3: Just okay. There are good and bad days.

2: We are feeling pretty stressed.

1: Not good. This is more than we can handle.

Have any of the following changes happened to you or your family in the past 6 months?

Not enough to eat

Loss of housing

Loss of income/job (you or someone in your house)

Divorce

Hospitalization of a family member or close friend

Separation from a caregiver/parent (prison, jail, moved away, deployed, foster care)

Death of a family member or close friend

What is your student's outlook about school? *

Dreading it! Doesn't even want to get out of bed.

Can't wait and ready to learn!

Is your child in need of any resources or support? (Check all that apply and include your name at the end of this form for support) *

Nothing needed at this time

Help with schoolwork

School supplies

Access to technology

They need to be connected with a trusted adult

Access to mental health support

Other: Please describe in comments below

Required

Have you noticed any of the following behaviors in your child that are new or have gotten worse? *

Change in sleeping patterns (sleeping more or less than usual)

Change in eating patterns (eating more or less than usual)

Mood Swings

Signs of worry or anxiousness

Expressing hopelessness

Little interest in doing things

Difficulty concentrating

Not able to stop or control worrying

Irritability

None of the Above

Other:

Required

Has your child expressed suicidal thoughts? *

Yes - Suicide Hotline: 1-800-273-8255 or Text "Home" to 741741

Currently not expressing suicidal thoughts, but has in the past.

Person(s) name filling out the form *

If you would like a one-on-one connection or would like any support, please include the best way to contact you.

Any other comments:

Submit

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