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.

Sign in to Google to save your progress. Learn more
Parent Name (First and Last) *
Best Phone Number (please enter (xxx) xxx-xxxx) *
Student's First Name: *
Student's Last Name: *
Grade *
Teacher Name (last name only) and Room Number *
Do you have any of the following concerns for your child at this time? *
Do you need help: *
Would you like me to *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Dallas Independent School District. Report Abuse