Hello, I'm glad you are checking in today!

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This is a brief check in so we know how you are doing at home. Please let me know if you would like for me to contact you. Also, please know that you can fill out this form anytime your situation changes. ~ Mrs. Simmons

First and Last Name *

Grade *

Pre-K

Kindergarten

First Grade

Second Grade

Third Grade

Fourth Grade

Fifth Grade

Homeroom Teacher's Name *

How do you feel today? *

I'm great!

I'm okay.

I'm struggling a little bit.

I'm not great, can I have a check-in?

How are things going at home? *

Terrible

Things are great

Does your family have enough food? *

Yes, we have plenty of food.

No, We would like some help getting food.

Do you have anything you want to share (I love good news!)

If you or your parents would like me to contact you, please leave a contact number below.

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