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Counselor Request Form
If you would like to speak to the counselor (Mrs. Tashia Kerins), please complete the Student Counselor Request Form for your request to be processed. 
Email *
Student First Name
Student Last Name
Grade Level
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Reason(s) for Request
Briefly Explain Concern Listed Above (Optional)
Relation to Person Completing Referral for the Student
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* Name/Contact Information of the person referring the student:
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