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)
* Required
Email address
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Your email
STUDENT INFORMATION
LAST name
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Your answer
FIRST name
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Your answer
Student ID number
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Your answer
Grade
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9
10
11
12
Click all that apply
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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.
Other:
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Brief description of what you would like to meet about.
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Your answer
What type of meeting do you prefer?
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Virtual Meeting (Zoom meeting requests will go to your OUSD email accounts)
Phone appointment
Email response (Responses will go to your OUSD email accounts)
Other:
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.
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Your answer
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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Yes I understand. This is not a serious situation that requires immediate attention.
Required
Send me a copy of my responses.
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