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I need to see the school counselor
Electronic form to request time with the school counselor
* Indicates required question
Email
*
Record my email address with my response
Your Name
*
ex. Christine Smith
Your answer
How can I help?
*
I have things going on outside of school
I am having a conflict with friends
I have exciting news
I am having trouble with an adult
I am having a hard time with school work
I just want to hang out sometime
I have a high school/college question
I am the target of aggressive behavior
I have a concern that is not on the list
I am struggling with my emotions
I need to report something I saw or heard
I need a quiet space
Required
What Zone are you in right now?
*
Blue
Green
Yellow
Red
How are you feeling?
embarrased
Annoyed
Proud
Sleepy
Out of Control
Scared
Hopeful
Happy
Hungry
Guilty
Angry
Confused
Calm
Hurt
Depressed
Anxious
Irritated
Excited
Nervous
Overwhelmed
If this is a problem, then how big is the problem to you?
0 Hiccup; I can fix this myself
1 Little; I just need a reminder
2 Medium; I need a little help
3 Big; I need help to calm down and reset
4 Gigantic; I need a lot of help soon
5 Emergency; I or a friend is in immediate danger
Clear selection
Additional Comments
*
Anything that can help explain your situation. Only Mrs. Smith can view these responses. You can also email her at
csmith@auroraacademycharter.com
Your answer
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