JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Counselor Check-In
Please fill out a quick survey if you would like to speak with your school counselor
Sign in to Google
to save your progress.
Learn more
* Indicates required question
What is your first name?
*
Your answer
What is your last name?
*
Your answer
What grade are you in?
*
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Who is your counselor?
Ms. K (grades K-2)
Mrs. Keenan (grades 3-5)
Ms. Joy (K-5 Social Worker)
Clear selection
How are you feeling?
Happy
Sad
Stressed/Anxious
Confused
Angry
Other
Clear selection
This is:
An emergency
Very important
Can wait
Clear selection
What calming skills did you try?
Take deep breaths
Draw a picture/Color
Read a book
Count to 10
Talk to a friend
Listen to music
Exercise (go for a walk, play outside)
Relax
Other:
Clear selection
Is there anything you want to share?
Your answer
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
This form was created inside of Bristol Twp School District.
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report