Nancy Cory Counseling Virtual Check-In Form
Hello! I am Ms. Torres, your school counselor!   This form is a way for me to know how you are doing. You can fill this out as many times and as often as you wish.  Daily or weekly or whenever you feel like it!  You MATTER to me!

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First & Last Name: *
Grade: *
Who is your teacher?
Are you meeting with your teacher in the.....
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Rate your answer!
How are things overall? *
Things are great!
How is your school/ digital learning going? *
Things are great!
How are things at home? *
Things are great!
What are some things you are doing to stay busy? *
I will be calling students to check in if needed. Would you like a phone call from me? *
What is the best phone number to reach you?
Please let me know about any questions, concerns, or worries you may currently have.
**Important Reminder**
This form is for non-emergencies only. If it is an emergency (thoughts of harming yourself or others), do NOT email your School Counselor. Call 911 or text HOME to 741741 or call the National Suicide Prevention Line: 1-800-273-8255. If you have immediate concerns for a child's safety and/or believe they are victims of abuse, please make a DCFS report or call 911.

Please understand that confidentiality cannot be guaranteed via phone conferences. We will make every effort to ensure a confidential conversation, and as always, we will notify the appropriate persons if any of the following come up in our conversation:
1. Someone is hurting you.
2. You want to hurt someone.
3. You want to hurt yourself.
4. You give us permission to share with another trusting adult.
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