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Parent Check In Request
Dear Star parents,
If you would like to connect, please answer just a few questions in order to help me better understand your and your child's feelings and needs. I will contact you during regular school hours between 8:00 am - 3:15 pm.
Sandra Rodriguez
sandra_rodriguez3@cjusd.net
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* Indicates required question
Email
*
Your email
Name of person completing the form
*
Your answer
Relationship to Student
*
Mom
Dad
Guardian
Student's first AND last name
*
Your answer
Teacher's name
*
Your answer
Grade level
*
TK/ Kinder
1st
2nd
3rd
4th
5th
6th
What are the concerns your child is having (Check all that apply)
*
Feeling anxious or stressed
Loneliness/ isolation
Friendship issues
Getting along with siblings/family members
Managing their time
School work
Access to technology
Coronavirus
Resources (in optional info please type what resources you need)
Other:
Required
Optional background information about your concerns
Your answer
Has your child tried any coping skills (deep breathing, creative activity, exercise, talking it out, etc)? Which ones?
*
Your answer
Who should I contact first?
*
Mom
Dad
Guardian
Contact student to check in
Other:
How would you like a response to your request?
*
Video call with student
Telephone call
Email response (to send resources you indicated above)
Required
Please give email or phone number to reach you or your child
*
Your answer
Best time to reach you
*
8:00-10:00
10:00-12:00
1:00-3:00
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