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.
* Required
Email address
*
Your email
Who is filling out this form?
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Your answer
Do you want Mrs. Nina to meet with you or someone else?
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I want to meet with Mrs. Nina
Other:
What is the meeting about?
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Academic Concern
Career Planning/College Concern
Schedule Concern (please fill out this form also:
https://forms.gle/MNdHMxc3MkVVrQrf8
)
Bullying (please fill out this form also:
https://forms.gle/yHEaBeiRunEr37Pk8
)
Need to talk about emotions or a problem at school or home
Online Course Concern
Other:
Required
Please briefly explain:
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Your answer
How urgent do you think this is?
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Choose
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.
Submit
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