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Student Support Check In
You can use this form to request a check in with Ms. Altieri, Mr. Meza and/or Ms. Torno.
If you are experiencing an EMERGENCY (you are worried about your safety or the safety of someone else) please find your adult and talk with them, use SAFE2Tell (
safe2tellco.org
) and/or call 911.
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* Indicates required question
Last Name
*
Your answer
First Name
*
Your answer
Please select one
*
Student
Parent/Guardian
Other:
Contact Phone Number
*
Your answer
Email Address
*
Your answer
Preferred Method of Contact
*
Phone Call
Text
Email
Video Chat
Schoology Message
Required
How are you feeling right now?
*
I'm really struggling
1
2
3
4
5
Things are great
Primary area of concern:
*
Academic (Online coursework, scheduling concerns, graduation, stress/workload, concurrent enrollment, ASCENT, other)
College & Career (College search, college applications, FAFSA, scholarships, next steps, other)
Mental Health (Depression, anxiety, loneliness, relationships, stress, other)
Home Concerns (financial, food, resources, other)
URGENT -- Use
safe2tellco.org
or call 911. Do not wait for a response. Your safety is important to us!
Other:
Required
Who would you like to connect with?
*
Ms. Jill Altieri, School Social Worker
Mr. Nestor Meza, Post Secondary Coach
Ms. Kaylee Torno, School Counselor
Required
Additional information you would like to include:
Your answer
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