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Student Counseling Referral
Please fill out form completely and a Counselor will contact you.
If this is a TRUE emergency please contact Counselors by phone or stop by the Counseling office.
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* Indicates required question
Student's First name
*
Your answer
Student's Last Name
*
Your answer
School ID Number
*
Your answer
Grade
*
Choose
6
7
8
Who is your Counselor?
What letter does your LAST NAME begin with?
A-L~Mrs. (Gunter) Reese
M-Z ~ Ms. Hartman
Clear selection
Reason to see a Counselor
*
Please select from an option below. If "Other" please explain.
Classroom Problems
Personal
Schedule
Goal Setting
XELLO
Other:
Required
I need to see you...
Right away = BIG problem
RIGHT AWAY
Sometime today
Sometime this week
How do you prefer to have your counselor contact you?
*
Email
Phone
Canvas
Call me down from class
How are you currently attending school?
*
Virtual
On campus
Is this an anonymous request?
Your answer
Telephone Number
*
Your answer
Submit
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