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JUST A SPECIAL CHECK ON A SPECIAL STUDENT

Student_________________________________________________________ Teacher_________________________________ Date__________________

Please check any item below that describes this student:

Appears happy lately Appears angry lately Lacks self-control lately Seems to be trying harder Appears to be socializing with others lately Appears to isolate himself/herself lately Could use a counseling appointment to talk about______________________

Thanks for all you do for our students! [Your Name]

JUST A SPECIAL CHECK ON A SPECIAL STUDENT


Student_________________________________________________________ Teacher_________________________________ Date__________________

Please check any items below that describes this student:

Appears happy lately Appears angry lately Lacks self-control lately Seems to be trying harder Appears to be socializing with others lately Appears to isolate himself/herself lately Could use a counseling appointment to talk about______________________

Thanks for all you do for our students! [Your Name]

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