Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Bi-Weekly Check-In
This survey will be used by the Mental Health Team at Brady High School to help and connect with you during the school year. Please answer each question as honest as possible.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Cell Phone Number
Your answer
General Mood
*
Extremely Unhappy
1
2
3
4
5
Happy
Stress Level
*
Extremely Stressed Out
1
2
3
4
5
No Stress
Do you need to speak with a counselor?
*
Your answer
Do you need help with any of the following?
Food
Transportation (Hybrid students)
Supplies
Academic Support
Technology Support
Mental Health Support
Coping Skills
20 QUESTIONS TO HELP CHALLENGE NEGATIVE THOUGHTS:
https://www.mcgill.ca/counselling/files/counselling/20_questions_to_challenge_negative_thoughts_0.pdf
First Name
*
Your answer
Last Name
*
Your answer
Who is your counselor?
*
Choose
Mrs. Susana Telleria (On-Line/Bridge)
Ms. Naomi Aranda (2nd Floor)
Ms. Denise Williams (3rd Floor)
I'm Not sure
Option 1
Clear selection
Option 1
Clear selection
Option 1
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Jefferson County Public Schools.
Report Abuse
Forms
