Hello, Bean Broncos! This is Mrs. Arias, School Counselor. Please use this form to check in with me or you can email me at emma.arias@lubbockisd.org.

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Please use this student self-referral form if you need my help or use it to just say hi. Let me know how you are and what you need. I would love to hear from you!
Love, Mrs. Arias
*Mrs. Arias is the only one that will get a response.

Student Name *

Grade *

How are you doing today? (you may check more than one box). All feelings are okay and may change from day to day.

Great!

Just okay

Worried

Confused

Angry

Sad

Scared

Not sure how I feel

I've been sick and not feeling well'

Other:

What do you need from Mrs. Arias?

Big Problem! Need to talk to you soon.

Little problem. Need to talk to you when you have time.

I have a question for you.

Need school supplies.

I'm good. Just checking in and want to say hello.

I need a virtual hug or high five from Mrs. Arias.

A reminder that I am an awesome kid and love my school family!

Need to share some good news!

Other:

Clear selection

How long did it take you to do today's assignments?

less than 1 hour

2-3 hours

3-4 hours

more than 4 hours

Clear selection

Is there anything else you would like to share with Mrs. Arias?

Submit

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This form was created inside of Lubbock Independent School District.