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Request for Counselor Support 23-24
Academic, Social/Emotional or Attendance. Please note that teachers are expected to make the first phone call home.
* Indicates required question
Email
*
Record my email address with my response
Your name
*
Your answer
Student's counselor
*
9th Grade Mainstream and Newcomer - Amber Wilson
10th Grade Mainstream and Newcomer - Maria Servellon Segovia
11th Grade Mainstream - Bethany Kwan
12th Grade Mainstream - Lena Rodriguez
11th- 12th Grade Newcomer - Amanda Vasquez
Student's First Name
*
Your answer
Student's Last Name
*
Your answer
Please choose the category that best describes the nature of your concerns.
*
Attendance
Cutting Class
Academic
Social/Emotional Support
Other:
Required
Please briefly describe your concerns about this student.
*
Your answer
What prior interventions have you tried? Please check all that apply.
*
Met with student
Reached out to other teachers who teach the student for support
Reached out to case manager (if student has IEP)
Called parent/guardian
Wellness Referral
Modified classroom assignments
Gigi (Attendance)
Other:
Required
Is there anything else you would like to add?
Your answer
Translation Line
Your answer
Send me a copy of my responses.
Submit
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