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First & Last Name
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Grade Level: K, 1, 2, 3, 4, 5, or 6
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Teacher
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Today I am  (check all that apply)
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Happy
Excited
Sad
Anxious
Hungry
Silly
Tired
Lonely
Bored
Overwhelmed
Other:
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Give a few details as to why you feel that way.
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Is there anything you want to talk about today?
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Today I am planning to (list school plan)
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Today I am planning to (list something fun you are going to do)
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Is there something you would like your teacher or someone else to know today?
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Is there something you need from your teacher? If so, explain what that is.
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Are you hurting today? If so, describe what is hurting.
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