Robbins Elementary

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Robbins Elementary

Hi Robbins Student/Family!

This form is a way for you to share information with me so that I then know how to best support and help you. Once you've answered the questions below, go ahead and submit it. I'll be in touch with you shortly to respond to your questions, concerns, and needs.

Looking forward to our conversation!
~Ms. Raskie, Robbins Elementary School Counselor

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Your name: *

Today's Date *

MM

/

DD

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YYYY

I am a... *

student.

parent/guardian.

Grade level and classroom teacher:

I would like help and support with: *

A friend/other people.

Schoolwork.

Family/home.

Something else.

Technology

Is there something else you would like for me to know?

How would you like Ms. Raskie to contact you? *

Phone call

Email

Video Chat

I can be reached at: *

Add your phone number or email address below. If you choose video chat, know that we will first get in touch over email or phone call.

Size of the problem: *

Sun- No problems for me. I have good things to share!

Cloudy- A small problem.

Rain- A medium problem.

Stormy- A BIG problem. If this is an emergency, talk to the nearest adult.

Submit

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