4/2/2020 SEA Check-In

SEA Check-In
Hello everyone! We understand that the impact COVID-19 has had in our community can be
challenging and uncertain. Know that the counseling team is working really hard to ensure you
continue to receive the services that you need virtually. We also want to check-in with you all to
see how you are doing. Please fill out this form by answering the following questions.
* Required

1. What is your name? *

2. What grade are you in? *

3. Please add a cell phone number we can reach you at. *

4. Is it okay to add this number to Remind so that the counseling team can
communicate with you for additional support?

Mark only one oval.

Yes

No

5. Type one word that describes how you are feeling. *

6. How are you taking care of yourself? *

https://docs.google.com/forms/d/1V7bAmcmQAeS4O9C5vxn-3HNLRDhl7QNuJyAqDxkIGTU/edit 1/2
4/2/2020 SEA Check-In

7. Indicate what services you are currently in need of if any. *

Check all that apply.

Food
Computer/Laptop
Internet
Textbook(s)
Materials (paper, pencil, etc.)
Other

8. If other, please indicate the service that you need below.

9. Attached is a list of services available to students and families in the NLMSD community.

Mark only one oval.

https://docs.google.com/document/d/1NuY4VyGodFnVDCnsVmLOKHXhudKQTwEK2RFryrTOu_
4/edit?usp=sharing

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 Forms

https://docs.google.com/forms/d/1V7bAmcmQAeS4O9C5vxn-3HNLRDhl7QNuJyAqDxkIGTU/edit 2/2