Request to see a School Counselor / Solicitud para ver a un consejero escolar

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Please fill out this form to see a School Counselor at Rio Lindo Elementary School. We will call you based on your level of need.

Please let a parent/guardian or an adult know if this is an EMERGENCY ( someone is hurting you, you want to hurt someone else, or you are thinking of hurting yourself).

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Complete este formulario para ver a su consejero escolar en la Escuela Primaria Rio Lindo. Le llamaremos según su nivel de necesidad.

Informe a su padre/ tutor guardian o a un adulto si se trata de una EMERGENCIA (si alguien te está lastimando, quiere lastimar a alguien más o estás pensando en lastimarse).

Email *

Student Name ( First and Last Name ) Nombre del Estudiante ( Nombre completo) *

Teacher Name ( Nombre de Maestro )

How do you feel today? ( ¿Como te sientes hoy? ) *

Great (Genial )

Good ( Bien)

Okay

Not so good ( No tan bueno )

Terrible ( Terrible)

Is there anything else you want me to know? ( ¿Hay algo más que quieras que sepa?)

Best way to contact you? ( La mejor manera de comunicarme contigo)

email ( correo electronico)

phone ( telefono)

Other:

Clear selection

Send me a copy of my responses.

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