2020 - 2021 Student Counselor Request Form

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Please complete the following form so that we can best meet your needs based on your specific concern. All responses are only accessible by designated staff. Thank you for your cooperation and we look forward to assisting you!

Mrs. Smith is the Counselor for all 6th grade students and the 7th graders on the Pacers Team. Mrs. Bradley is the Counselor for the 7th grade students on the Mavericks Team and for all of the 8th grade students.

Your First and Last Name *

Grade Level *

6th Grade

7th Grade

8th Grade

Homeroom Teacher *

How are you currently participating in school? *

Face to Face on A Days

Face to Face on B Days

Remote Learning Every Day

What do you need assistance with? *

Scheduling question

I am failing one or more classes

Personal problem

I have a concern about a friend

I am having a conflict with another student

Other

Required

We will always do our best to meet with you as soon as possible, but please let us know how urgent is your concern. *

When you have time to see me

It's an emergency

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