This is a Google Form to be used by Psychologists, Social Workers and School Counselors to check-in with counseling students. It is particularly useful to be used for checking-in with students who are at home participating in remote or distance learning. The form is aimed to gauge how students are feeling, to let the counselor know if they would like to check-in 1:1, and to allow the student to share information/feelings with the counselor.

As is, the form gathers the following information: "Name", "Date", "How do you feel today?", "Please list three positive things going on in your life right now.", an option to request a 1:1 check in with the counselor and, "I would like Ms. XX to know...".

This Google Form can be customized/edited to fit your needs. There is an option for data to be output into a Google Sheets format to be used for data collection and to keep track of contact with students responding to the form. This is an easy way to document student outreach during the school shut-down!

Keep your students feeling that you are still available to assist them in discussing their feelings by reaching out using this form!