Parent Request for Counseling Assistance
Parents, we live in a time when we all need help in one form or another. You are not in this alone. You have a community of support and a huge bank of resources.
As the School Counselor, I am here to help your child meet their academic, social/emotional and post secondary goals. I provide systemic support through multidimensional interventions, including classroom lessons, small groups and 1:1 counseling. These sessions are short term and solution focused.
I want to inform you that any information students share with me is confidential. The student’s right to privacy is guarded as much as permitted by law, ethics, and CPS policy. However, I am obligated to break confidentiality when there is potential harm to the student or others, concern of neglect or abuse, or a court of law that requires testimony or student records. However, if there is a major crisis, call 911 or go to your local emergency room.
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Parent Name (First and Last)
Best Phone Number (please enter (xxx) xxx-xxxx)
Student's First Name:
Student's Last Name:
Teacher Name (last name only) and Room Number
Do you have any of the following concerns for your child at this time?
Safety/Abuse (READ SECTION 2)
My child needs academic support
My child needs help with their feelings
My child needs help with family changes (i.e. Divorce)
My child needs help with goal setting (Organization)
My child needs help with coping with fear or loss (Grief)
My child needs help conflict management (Social Skills)
My child needs help with bullying (target and/or perpetrator)
Do you need help:
Finding an outside counselor
Getting my student motivated to work from home
Finding resources for food, clothing, etc.
Getting ideas and suggestions on how to support my child socailly/emotionally.
Would you like me to
Do a check in with your child
Provide you with resources, suggestions and tips on helping your child
Keep your child in mind if small groups begin
Contact you so we can talk more
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This form was created inside of Dallas Independent School District.