School Counseling Service Request Form

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Dear Students,

Please complete the School Counseling Services Request form below if you need to see a counselor. We will do our best to see you within a reasonable amount of time. Please only submit one request per day. Submit form and wait for a counselor to follow-up with you. Please do not come by the office to check or fill out another request until a counselor sees you.

Thank you,

The LHS Counseling Team

Email *

Student (Last Name, First Name) *

Counselor Requested *

Mrs. Little (A-I)

Mrs. Shumate (J-M)

Mr. Olson (N-Z)

Mrs. Flynt (CVCC Career Coach)

I need to see the counselor about: *

Academic Career Plan (ACP)

College Application/Transcript Request

Mediation (to resolve issue with a peer)

Personal/Social Concern

Schedule Change

Scholarship Information

Other:

Please provide more details about your request below

Please rate the level of urgency: *

Can wait

Must be seen immediately, emergency situation

A copy of your responses will be emailed to the address you provided.

Submit

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