Counseling Check In Request Form
Torrington Public Schools
Welcome and Explanation
Hello Torrington Public School Families,
In order to support our students in these challenging times, we have created a counseling request form that will allow us to prioritize and track follow ups to students in need of basic/first-aid mental health services. The goal is to help students, who may only need a periodic check-in, or who may be feeling challenged/overwhelmed in the present moment, with an organized way to reach out to their counselor, psychologist, or social worker like they normally would in person during the typical school week.
THIS IS FOR:
1. This is to provide quick social emotional support to students with a mental health provider who is familiar with the student.
2. This is to support students processing through barriers that prevent them from learning and engaging with the distance learning process.
THIS IS NOT FOR:
1. This is not for crisis situations. If you are in crisis, please immediately call 211 or 911.
2. This is not for regular IEP/504 service. Your mental health provider will be reaching out to the family of each student to set up a schedule and fulfill the related service time.
3. This is not for student needs beyond the purposes of school. For concerns unrelated to school, we have posted local community support agencies on our website.
As the student or parent/guardian, simply answer the five required questions and click submit. Our Torrington staff will be checking the submitted responses regularly and will reach out to the phone number you provide within the form. Please be patient as this is a new process aimed to help all of our students across the entire district.
Torrington Public Schools
Please enter first and last name. No abbreviations
Date of Request
Does the student normally receive counseling as part of an IEP or 504?
Social Worker/Counselor/Psychologist Requested
Forbes - James Dziekan
Forbes - Kim Keil
Forbes - Corey Wadlinger
Remote - Stacey Martwinski-Nardozzi
SW - Brandon Randall
SW - Pavinee Shea
TFD - Deb Mordecai (Carroll)
TFD - Emily DiConstanzo
THS - Aimee Greeley
THS - Claire Pepper
THS - Gaitan Rodriguez
THS - Barbara Beebe
THS - Ryan Dickens
THS - Jessica Odlum
THS - Elena Sileo
TMS - Kathryn Cannata
TMS - Kate Davis
TMS - Kari Patterson
TMS - Christel Doyle
TMS - Jamie Mascolo
TMS - Nancy Premier
TMS - Kristi Ramsey
VW - Mary Magnoli
VW - Ali Raza
Student Phone Contact Number
Provider will give you a call from a screened number.
Page 1 of 1
Never submit passwords through Google Forms.
This form was created inside of Torrington Public Schools.