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Checking In
Hi! It's Mrs. Rizzi. I created this form as a check in on how your are doing and if there is anything I can help with! Answer the below questions (as many or as few as you want). The more you answer the better as I'll have more information. Your answers are private and will only be seen by Mrs. Rizzi!
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Email
*
Your email
Hello & thank you for visiting!
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MM
/
DD
/
YYYY
Name (first & last)
*
Your answer
Grade
*
Freshman
Sophomore
Junior
Senior
How are you feeling today?
1 - Not good at all - I need a check in call or email
2 - Could be better
3 - OK
4 - Pretty Good
5 - Great
Clear selection
How is everything at home?
Your answer
What are some things you can do if you're not feeling like you are in a good place? (sad, mad, nervous, scared)
Your answer
What are some activities that you like to do while you are at home?
Your answer
Do you need a check in call?
Yes
No
Clear selection
If yes, do you prefer.... (I will email to schedule so please check your school email)
Phone Call
Google Hangout
Clear selection
Is there anything else you'd like to share?
Your answer
Send me a copy of my responses.
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