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Request to See a Counselor 2024-2025
Please fill out this form to request to see a counselor.
Counselors will try to call you in within 48 hours if available.
Please do not use this form for schedule change requests.
Click here if you would like to request a schedule change.
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* Indicates required question
Email
*
Your email
Your Name:
Your answer
Realtionship to Student
Choose
Self
Friend/Peer
Teacher
Parent
Staff Member
Other
Student Name (First and Last Name)
*
Your answer
Student ID# (lunch number)
*
Your answer
Grade
*
7th Grader
8th Grader
Counselor You'd like to see:
*
Ms. Cook (7th Grade Counselor)
Mrs. Denny (8th Grade Counselor)
Mrs. Gomez (MTSS Counselor)
Ms. Alejandra Alvarado (SAP Counselor)
What do you need to see your counselor about?
*
Academic Issues
Family Issues
Feelings (anger, sadness, lonely, overwhelmed, anxious, etc)
Friendship/relationship issues
Future Plans (high school, college and career)
Grades
Grief
Promotion status
Schedule/Classes
School Supplies
Teasing/Harassment/Bullying
Other:
Comments (Information you'd like your counselor to know about your request.)
Your answer
If you are feeling unsafe or in a crisis situation, please call 911 or the National Suicide Prevention Lifeline at 1 (800) 273- TALK (8255). Visit our districts wellness web site for hotline and textlines information at
https://sites.google.com/riversideunified.org/rusdvirtualwellnesscenter
.
A copy of your responses will be emailed to the address you provided.
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