School Counseling Service Request Form
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.
The LHS Counseling Team
Student (Last Name, First Name)
Ms. Whorley (A-D)
Mrs. Shumate (E-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)
Please provide more details about your request below
Please rate the level of urgency:
Must be seen immediately, emergency situation
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Bedford County Public Schools.