I would like to meet with Miss P, please.

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Please complete the information below if something is getting in the way of your learning. I will receive notice and make a plan to see you as quickly as I am able! PLEASE NOTE: If this form is completed over the course of a weekend, holiday, or school break, Miss P. will receive notice of the message on the day we return to school.

Email *

First Name *

Last Name *

Teacher *

What feeling do you need help with today? *

Too excited

Worry or anxious

Sad

Scared

Mad or angry

Overwhelmed

Other:

I want to talk about... *

On a scale of 1-10 ("1" meaning it's not a problem at all and "10" meaning it's a big problem), how much are these thoughts and feelings getting in the way of learning today? * *

Not a problem at all

Huge problem

A copy of your responses will be emailed to the address you provided.

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