Counselor Check In
Hi! It's Mrs. Jefferis, your School Counselor at Cypress Creek Elementary School. I am checking in to see how you are doing and to see if there is anything that I can help with. Answer as many or as few as you'd like - the more, the better! Your answers are private to Mrs. Jefferis only.
How are you feeling today?
1 - Not good at all (I need a check in call)
2 - Could be better
3 - Okay
4 - Pretty good
5 - Great
How was your breakfast or lunch?
How is everything at home?
What are some strategies you have used or could try when you have uncomfortable feelings (like being sad, angry, nervous or scared)?
What are some activities that you like to do while you are at home? Things I enjoy are...
Do you need a check in phone call from Mrs. Jefferis?
Anything else you would like to share?
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This form was created inside of Volusia County Schools.