In order to help us better work together, please complete the following checklist for each child. This information will remain confidential and will not be included in your child's student record. All information will be utilized to enhance their learning experience and to guide the Yeshiva in maintaining a sensitive perspective in encouraging classroom adjustment. We look forward to beginning the school year soon!

Parent's Name*
Name of Child*
Division*
Family members in the home contracted the Covid 19 virus*
My child experienced loss of a family member*
My child has experienced other distress during this time*
My child has coped well and been very productive during this time*
Our family has undergone some significant changes*
I have noticed changes in my child which might affect their schooling*
My child had difficulty keeping up with the lessons during this interval*
My child may have fallen behind in his or her study habits and concentration*
My child is looking forward to returning to Yeshiva and seeing friends*
My child is concerned about social interactions when returning to class*
I have concerns about my child's reintegration into the classroom*
I feel that my child might benefit from some time with the school counselor*
I request a private consultation with the administration or teacher to discuss concerns related to my child's return to Yeshiva*