NAMS School Counselor Family/Student Check-In
THIS FORM IS FOR NON-EMERGENCY CHECK-INS ONLY. IF YOU ARE IN AN EMERGENCY SITUATION, PLEASE CALL 911 IMMEDIATELY.
Please fill out this form to help me know what your needs are so that I can best support you and your children during this time. You may also contact me by email, Ms. Julie Newton, at
Name of Person Completing Survey
What is the best phone number to contact you?
Name(s) of Students Who Attend NAMS
How are you and your family doing? Check all that apply.
We are doing well.
We are doing ok.
We are not doing well at all, either physically or emotionally and would like some assistance.
Please call us. We would like to talk.
We are struggling with.....Check all that apply.
Completing Work from school
Communicating with teachers and school staff
Household necessities (food, paper products, personal hygiene items, etc.)
We are going stir crazy! We need ideas on how to keep the kids' occupied
Social/Emotional Issues (stress, anxiety, sadness, relationships, etc.)
Are you in need of any of the following resources?
LifeCore Counseling Services (longer term counseling)
No, thanks! I have everything that I need.
Is there anything else that you would like for us to know about?
Never submit passwords through Google Forms.
This form was created inside of New Albany City Schools.