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.
Who is filling out this form?
Do you want Mrs. Nina to meet with you or someone else?
I want to meet with Mrs. Nina
What is the meeting about?
Career Planning/College Concern
Schedule Concern (please fill out this form also:
Bullying (please fill out this form also:
Need to talk about emotions or a problem at school or home
Online Course Concern
Please briefly explain:
How urgent do you think this is?
Extremely urgent: I am in danger or someone else is
Very Urgent: it is really important that this is handled by the end of the day because of a deadline or because I am reporting bullying
Urgent: I am in emotional distress and really need support today
Important, but not urgent: I can wait a day or two to meet with you
Not very urgent: as long as we talk within the next week it will be ok
Send me a copy of my responses.
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This form was created inside of Hanover School District #28.