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Student's Request to See the Social Worker
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First and Last Name
Date
MM
/
DD
/
YYYY
Grade and Teacher
I would like to talk about:
How I want the Social Worker to contact me:
What I want to talk about is:
I also want the Social Worker to know:
Please remember that you can join my text line by texting @mrsperez21 to 81010. You can also call me at 940-569-1411 X1113 or e-mail me at adria.perez@burkburnettisd.org
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