Parent Support Survey
Hello! My name is, Alicia Klinker, and I am the counselor at Patriot. I am collecting some information on what groups would be beneficial for your students to participate in throughout the year and ask that you please fill out the form below. Please only select two groups total in case your first choice is full. If you have more than one student enrolled, please fill out a separate one for each. Groups run 6-8 weeks with one session a week and will rotate throughout the year. Groups will be much smaller this year due to COVID so if you do not feel they need to participate, please do not fill out the group portion. Thank you so much and please feel free to contact me with additional questions or concerns! 719-382-1460
Child name *
Grade *
What kind of groups would be helpful for your student? Please only pick your top two if you wish for your child to participate in group.
Has your child's learning been significantly impacted by any of the following in the past year?
Any additional things your child might need support with?
Anything else you would like the mental health team to know?
Would you be willing to allow your child to participate in group? You will receive a permission slip in weeks leading up to group if your child is placed in one. Groups will be smaller this year due to COVID. *
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