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Counselor Request Form
Use this form to request a visit with Ms. Sands! :)

STRONG enough to stand alone,
SMART enough to know when you need help and,
BRAVE enough to ask for it.

**PLEASE NOTE: This referral form will be checked during school hours. Monday-Friday 8:00-4:00. If you have an emergency outside of these hours, I advise you to speak with a trusted adult until I can see you during school hours.
Thank you!

First name: *
Your answer
Last name: *
Your answer
Grade *
Homeroom Teacher's name *
Your answer
Reason I need to see a counselor *
I would like to see you...
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