Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Counselor Request Form
Please fill out this request form if you are needing to meet with the Counselor.
* Indicates required question
Email
*
Record my email address with my response
Name
*
Your answer
I would like to see the Counselor because
*
I have a problem at home or with family
I have a problem at school
I have a problem with my friends or peers
I need to discuss my schedule
I need help with resources for myself or family such as food, clothing, hygiene, items, etc.
I need to talk about something else
Is this matter urgent? (**Urgent means you are worried about the safety of yourself or others)
*
Yes
No
I am not sure
Is there anything you would like the Counselor to know before we meet?
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Eudora USD 491.
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
