Gateway Counseling Department Requests Q4
Please complete this form to request an appointment with your counselor.You will be sent a pass with an appointment time.
Your First Name
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Your Last Name
Your answer
I am a
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Contact information (enter your cell number, email address, or other contact information here)
Your answer
Student ID # (if applicable, otherwise write N/A)
Your answer
Language preference
Your answer
Grade
Who do you need to see?
When would be the best time to talk? (Counselors will do their best to honor your request, but may need to make an exception. Check all that apply.)
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What are you interested in talking about?
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Please tell us more about what you would like to discuss (for example, what class/program are you wanting to change and why; description of question issue) The more information you can provide, the better we can meet your needs. :
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