Thanks for checking in with me today!

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete this brief check in form so that I know how you are doing at home.

Email *

What grade are you in? *

6th

7th

8th

How are you today? *

I feel great!

I feel fine.

I'm struggling a little bit.

I'm not doing so well. Can you reach out to me?

How is your learning going? *

I am on track, and all my work is complete so far.

I am doing ok. I have done some work, but still working on a few things.

I have done a little, but I am definitely falling behind.

I have hardly done any because I have other responsibilities.

I have hardly done any because I don't want to.

I have hardly done any because I am so confused.

Required

Today I am planning to (list school plan) *

Today I am planning to (list something fun you are going to do)

Is there anything you need? (school supplies, a locker, etc.) *

Do you have any friends you are worried about? *

** Important information ** This form is for non-emergencies only. If this is an emergency (thoughts of harming yourself or others), please go directly to the Counselor's Office and someone will address your needs immediately. If you have an emergency and you are not at school, call 911 or go to the nearest emergency room. Help is also available at the National Suicide Prevention Lifeline 1-800-273-8255/text HOME to 741741. Mental health support for Texans experiencing anxiety, stress, or emotional challenges due to the COVID-19 pandemic - 24/7, toll-free (833) 986-1919.

Please understand that if I am concerned you may harm yourself or others, or that someone is causing you harm, I will notify the appropriate persons.

Click "Agree" below to confirm that you read the statement above and will check your Teams chat for my message. *

Agree

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Lackland ISD. Report Abuse

Forms