Middle/High School Check-In
The below survey questions are designed to assist each person with self-reflecting with how you are feeling each Thursday morning. If you would like to speak with a staff member, please feel free to write this in your response. Your answers will go directly to Mr. Miller.  

If you answer no to any of the questions, please answer why!!!

Students will complete each Thursday morning.

1. If a student answers a question no, Mr. Miller will inform the teacher to determine the severity of the situation.
2. After the teacher determines the severity of the situation, the teacher will contact the parents and/or contact the guidance office if needed.  
3. The Counseling Center will counsel the student and work with the administrative team to access the best interest of the student.
4. The Counseling Center will counsel the student and work with the administrative team to access next steps for the student.

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First Name/Nombre de pila *
Last Name/apellido *
Grade/Calificación *
Overall my school week was positive? *
If I marked no, why do I feel my school week was not positive?
How are you feeling today? *
If you marked sad, frustrated, or upset, why did you mark that?
I was not teased, insulted, or verbally harassed in school this week? *
If you marked no, what happened?
If I have a problem, I can solve it or find someone who can help me solve it? (Friend/Staff Member) *
If I marked no, why do you feel you cannot speak to a friend of staff member about how you are feeling?
I do not need to speak to my “Go To Person” today? A "Go To Person" is someone I feel comfortable and happy speaking with. *
Who is my "Go To Person" at school?¿Quién es mi "persona a la que acudir" en la escuela? *
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