Check-In with Mrs. Nina Request Form

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

You must fill out this form to meet with Mrs. Nina out of class unless it is an EMERGENCY. If you are feeling like self-harm or are having thoughts of suicide or harming others, please let your teacher know it is an emergency you see Mrs. Nina. If you have a scheduled weekly check-in with Mrs. Nina, DO NOT fill out this form unless it is an emergency, otherwise, she will pull you by the end of the week.

Email *

Who is filling out this form? *

Do you want Mrs. Nina to meet with you or someone else? *

I want to meet with Mrs. Nina

Other:

What is the meeting about? *

Academic Concern

Career Planning/College Concern

Schedule Concern (please fill out this form also: https://forms.gle/MNdHMxc3MkVVrQrf8)

Bullying (please fill out this form also: https://forms.gle/yHEaBeiRunEr37Pk8 )

Need to talk about emotions or a problem at school or home

Online Course Concern

Other:

Required

Please briefly explain: *

How urgent do you think this is? *

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Hanover School District #28. Report Abuse

Forms