School Counseling Check-In Form

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School Counseling Check-In Form

I'm so glad you are here!

This check-in form is a way for me to do my best to help you while we are not in school together. I want to support your needs even if I can't be with you in person.

The answers you give are completely private and will only be seen by the counselor. Your well being and safety is a priority. Please submit the form when completed and I will meet with you as soon as I can.

Thank you for checking in with me!

Love,
Mrs. Finch
Skipwith Elementary School Counselor

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Your First and Last Name: *

Your teacher's name: *

What grade are you in? *

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

How are you feeling today? *

Happy

Sad

Mad

Scared

Worried

What can I help you with today? *

A problem at home with my family

A problem with a friend

Something happening in school

Other

What size problem are you having? *

Small Problem (I am a little upset and would like to talk to Mrs. Finch when I can)

Medium Problem (I am very upset and need to talk to Mrs. Finch today or tomorrow)

BIG Problem (I am extremely sad or mad and need to talk to Mrs. Finch right away!)

Thank you for submitting this form! I will get back to you as soon as I can.

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