Counselor Request Form
Please complete the following form to request a meeting with a Counselor.
Who is completing this form?
Who would you like to speak with?
Ms. Moehlau (Team 1 and 7th grade Counselor)
Mrs. Kapernick (Team 2 and 8th grade Counselor)
Mr. Koshko (Social Worker)
Reason for Request
Needs Break from Class
Describe the details of your request (optional)
What is the best way for us to contact you while we not at school? Enter your phone number and/or email address below.
Would you like to schedule a video meeting with your counselor?
Yes. Please contact me to make arrangements.
Not at this time.
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