Request edit access
Request to See a Counselor
Please fill out this form to request to see a counselor. Counselors will try to call you within 48 hours if available.
Sign in to Google to save your progress. Learn more
Email *
Your Name:
Realtionship to Student
Student Name (First and Last Name) *
Student ID# (lunch number) *
Grade *
Counselor You'd like to see: *
What do you need to see your counselor about? *
Comments (Information you'd like your counselor to know about your request.)
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.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Riverside Unified School District. Report Abuse