Counselor Appointment Request: Valentin (San-Z)
Please Read: Counselors are here to support you with any questions or concerns you may have. You may email Mrs. Valentin at dvalentin@orangeusd.org or fill out this form and to schedule a meeting. If this is an emergency (thoughts about self harm or concern for friend's self harm) please immediately speak with a trusted adult or call Crisis Text Line: Text “HOME” to 741741 or National Prevention Lifeline: 1-800-273-TALK(8255)
Email address *
STUDENT INFORMATION
LAST name *
FIRST name *
Student ID number *
Grade *
Click all that apply *
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Brief description of what you would like to meet about. *
What type of meeting do you prefer? *
If you indicated you wanted a phone appointment, please put down the best number to contact you. Otherwise put NA if it does not apply. *
You understand that if this is an emergency or serious situation you are expected to seek a trusted adult immediately or call Crisis Text Line: Text “HOME” to 741741 or National Prevention Lifeline – 1-800-273-TALK(8255). Do not use this form for emergency situations. *
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