BMS Student Survey 2021-2022
This form is for us to get a little more information about YOU so we can help support you to the best of our abilities!!!
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First Name: *
Last Name: *
Check the box if there is something you would like to talk to the counselor or social worker about privately. *
Required
I am currently having thoughts about hurting myself, suicide, or hurting others. *
I received Backpack Buddies last year. *
Something I would like you to know about me is..... *
If you are interested in being in one of the following groups, please check the box next to it.
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