Request For Support - Appointment/Feedback Form
Parent/Guardian:
With distance learning, (30 min) check-ins are being offered for students who are experiencing elevated challenges and may be in need of additional support in the area(s) of:
* managing schedule/free-time/boredom
* managing relationships with others within the home
* managing challenging school work
* maintaining calming/energizing strategies
* managing fears/concerns/anxiety
This is not considered individual telehealth counseling, but referrals to other outside providers can be provided if requested.


With in-person learning now in effect, we are offering ( 30) min support groups and individual sessions. There will be 6 support session in total topic will include:
* Social Skills
* Mindfulness
* Worries/ Anxiety
* Changing Families/ Divorce



Please complete this permission/form. Mrs. Badak (School Behavioral Health Professional) or Mrs. Hanrahan (School Counselor) will be in touch with you as soon as possible. We want to help!
Student First & Last name, Grade, Homeroom Teacher *
My concern is *
Required
Check all that apply: *
Required
A brief summary of your concern (Optional):
Who is completing this form and relationship to the student? *
Please share your preferred method of contact to YOU (email/phone): *
By completing and submitting this form, you are giving permission for staff/student contact. Please check to indicate the methods you allow for contact between your child and Mrs. Badak and/or Ms. Hanrahan. *
Required
Continue to take care of YOURSELF, too!
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