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District 19's Wellness Check-in
We want to know how you are doing and the best way to support you and your child(ren) during this time. Please take some time to fill out this quick survey. Thank you in advance
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Students Name
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Your answer
Name of Person Completing the Survey
*
Your answer
Relationship to the student
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Parent
Guardian
Other:
Contact Number
Your answer
Email
Your answer
School
*
Your answer
How are you and your family doing? Check all that apply
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We are doing well.
We are doing okay. Thankful we are not sick.
We have sick family members, but we are doing okay.
We are not doing well at all physically, and would love some help.
We are not doing well at all emotionally, and would love some help.
Please call us. We would like to talk.
Other:
Required
We are struggling with....Check all that apply.
Technology
Completing work from school
Communicating with teachers and school staff
Household necessities (i.e., food, paper products, personal hygiene items, etc.)
Staying organized
Childcare
We are going stir crazy! We need ideas on how to keep the kids occupied!
Other:
I wish the school would...
*
Your answer
Any questions.
Your answer
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