Section 1 of 1
School Counselor Check-in 2023-2024
Mrs. Haywood is checking in to see how you are doing!
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First Name
First Name
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Last Name
Last Name
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Who do you live with?
Who do you live with?
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Dad
Mom
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Grade (Select)
Grade (Select)
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3rd Grade
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How was your summer?
How was your summer?
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How is your school year going so far?
How is your school year going so far?
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Do you have friends at school?
Do you have friends at school?
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A lot
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One
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Do you have anything bothering you outside of school?
Do you have anything bothering you outside of school?
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Yes
No
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Do you have anything bothering you at/about school?
Do you have anything bothering you at/about school?
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Do you have anything you want to talk to the School Counselor about?
Do you have anything you want to talk to the School Counselor about?
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Yes
Not right now
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If you answered "Yes" -what is bothering you at school or outside of school that you would like to speak with the counselor about?
If you answered "Yes" -what is bothering you at school or outside of school that you would like to speak with the counselor about?
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Anything else you would like for your School Counselor to know about you?
Anything else you would like for your School Counselor to know about you?
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