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
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)
Student ID number
Click all that apply
Academic - Schedule Adjustment (be specific in description below)
Academic - Questions regarding a Class/Progress/Graduation, College etc.
Career - Questions about CTE, or job future and interests
Personal - I have a question/concern I would like to address with you. It is not an emergency.
Brief description of what you would like to meet about.
What type of meeting do you prefer?
Virtual Meeting (Zoom meeting requests will go to your OUSD email accounts)
Email response (Responses will go to your OUSD email accounts)
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.
Yes I understand. This is not a serious situation that requires immediate attention.
Send me a copy of my responses.
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