School Counselor Request Form

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5th, 6th, 7th, and 8th graders - Please complete this form below if you would like to request the school counselor meet with a student or yourself. The school counselor is available to meet with students M-F from 8:00am - 3:00pm. IF THIS IS A MENTAL HEALTH EMERGENCY AND IT IS OUTSIDE OF THE COUNSELOR HOURS, PLEASE CALL 911 or 988.

Email *

Student Name(s) *

Reason: *

I have good news to share!

I am having a problem with a friend or classmate.

I am having a problem with a family member.

I am having a problem with a teacher.

I am struggling in class or with an assignment/homework.

Someone I know died.

I am having thoughts about hurting myself or someone else.

Someone I know is hurting themselves or another person.

Something else

I will meet with most students within 48 hours during the school week. Please indicate if you need to see me sooner. *

Yes, please see me sooner.

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