Student Well-Being Check-In

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Hello! I just wanted to take a minute to check in with you, some of my most important people! This is a FIVE QUESTION survey to help me see how you're doing and to learn more about how I can stay in touch with you in the upcoming weeks.

Your name *

How are you doing? *

GREEN LIGHT: I'm doing fine! I may not be perfect, I may be disappointed about some things, but I feel safe and connected to people who can support me.

YELLOW LIGHT: I'm doing okay. I have A LOT of questions about classes and grades and events, but I understand we'll get that information as soon as the school and teachers get information. I feel connected to people and have a support system I feel good about.

RED LIGHT: I not doing okay. I have a lot of anxiety. I don't always feel safe and need to talk with a counselor or teacher.

Technology check-in (please check all that apply) *

I have regular access to internet

I do not have regular access to internet

I have access to a subscription to Netflix, Hulu or Amazon Prime

Required

Any other details about technology (what you do or don't have access to) that would be helpful for me to know?

Anything else you'd like me to know?

Submit

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