Counselor Request Form
Your Student Services team is here to support you!  Please complete this form and someone from Student Services will be in touch with you.

6th grade: Ms. Emerson at
7th grade: Ms.Goemaat at
8th grade: Ms. Tersigni at

Social-Emotional Learning Specialist: Ms. Thompson at

If you or someone you know is in crisis, please dial 911, call the Colorado Crisis Hotline at 1-800-273-8255, or contact Safe 2 Tell at 1-877-542-7233 or
Sign in to Google to save your progress. Learn more
Email *
Student Name (First & Last) *
Grade *
I would like to talk to the counselor about: *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Jefferson County Public Schools. Report Abuse