COVID-19 Counselor Request
Please complete this form if your family needs any counseling services.
Email address *
Parent Name *
Parent Phone Number *
Student Last Name *
Student First Name *
I want to talk about: *
Please give some more information... *
Is this an emergency? *
Are you in need of any resources? *
If yes, please list the resource(s) needed.
By checking this box, I give permission to Ms. LeDet to have a video conference with my child using the Zoom App. *
Never submit passwords through Google Forms.
This form was created inside of Galena Park ISD. Report Abuse