Request edit access
Request to Speak with a School Social Worker
We are here to help.  By completing this form, you are acknowledging that you have reviewed possible resources for your specific circumstances and need further assistance with these resources.  This form is intended to help connect you with help during the current school closure, and is not meant to replace or duplicate a therapeutic session.  
Sign in to Google to save your progress. Learn more
Student Name *
Email address (please check this for a response) *
Have you spoken with a parent/guardian about your specific circumstances? *
Provide a brief description of why you are completing this form.   *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Elizabethtown Area School District.

Does this form look suspicious? Report

Google Forms