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Request to see the Counselor Form
If this is an emergency, please contact the office or Mrs. Hill by phone for immediate assistance. If not an emergency, Mrs. Hill  will contact you as soon as she is able to.
Email *
Student Name *
First and Last Name
Teacher *
Reason for Referral (check all that apply) *
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Concerns/Comments *
Interventions tried. *
Have you contacted the parent/ guardian about your concerns? *
Date the  parent was contacted *
A copy of your responses will be emailed to .
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