Counselor Request

Please fill out this form to see a school counselor! Thank you!

First Name *

Last Name *

Grade *

6th

7th

8th

Please click all that apply *

I am being bullied;

I feel unsafe;

I need to fill out a Blue sheet

Friendship/Relationship questions or concerns;

I want to talk about my schedule;

I need school supplies;

I have an issue with an adult

I need clothes(tshirt/shorts/pants/underwear/socks/shoes/etc);

Requesting a weekend food bag

I missed breakfast/lunch( I need a snack);

Required

When convenient- Not Urgent (Schedule Questions/Friendship/relationship concerns/school supplies, food or clothes)

Right Away - Emergency

Clear selection

Please state your reason why you'd like to talk to a Counselor if it is NOT listed above, thank you!

Submit

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