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Learning Lab Check In/Out
Please complete this form when you come to learning lab, and again before you leave!!
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Student Name
*
Your answer
Grade
*
6th
7th
8th
Lunch Number
*
Your answer
Whose class did you come from?
*
Your answer
Checking In or Out?
*
Checking IN
Checking OUT
Required
On a scale of 1-5 (1 being no stress at all and 5 being totally stressed out) how stressed do you feel RIGHT NOW?
*
1
2
3
4
5
What other feelings are you experiencing?
Sad
Worried
Jealous
Annoyed
Scared
Lonely
Guilty
Embarrassed
None
Other
What can we do to help you?
*
Your answer
Is there anything you would like to share with us?
*
Your answer
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