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Guidance Office Appointment Request - Mrs. Medina
This form is to be used any time a student requests to see his or her counselor.

If you are experiencing an emergency during the school day, DO NOT complete this form. Please report to Ms. Petty, the Guidance Secretary, and she will direct you accordingly.

Last Name
First Name
ID Number
Check which year you are in school.
Reason(s) for request (check all that apply)
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