Student - Counseling Appointments

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This form is for non-emergencies only!

If you have an emergency, please talk with your trusted adult right away.

If you need to speak to someone right away and are unable to speak to a trusted adult-

Text: LISTEN to 741741 Call 988 if this is mental health emergency

First Name *

Last Name *

Grade *

I would like to speak to you about... *

Social (problems with friends or other students)

Emotional (dealing with my feelings)

Academic (Grades/Schoolwork)

College & Career Planning

Other

Required

This visit is about... *

I understand that the counselor might not be able to see me today. *

Yes

I understand that if this is an emergency, I will contact a trusted adult immediately. *

Yes

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