Check-In with Mrs. Nina Request Form
You must fill out this form to meet with Mrs. Nina out of class unless it is an EMERGENCY. If you are feeling like self-harm or are having thoughts of suicide or harming others, please let your teacher know it is an emergency you see Mrs. Nina. If you have a scheduled weekly check-in with Mrs. Nina, DO NOT fill out this form unless it is an emergency, otherwise, she will pull you by the end of the week.
Email address *
Who is filling out this form? *
Do you want Mrs. Nina to meet with you or someone else? *
What is the meeting about? *
Required
Please briefly explain: *
How urgent do you think this is? *
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