JRT Student Request to See Counselor 
THIS FORM IS NOT TO BE USED FOR SCHEDULE CHANGE REQUESTS. THESE REQUESTS WILL NOT BE ADDRESSED BY SCHOOL COUNSELING. 

This form is for students to request a meeting with your school counselor. Please keep in mind that your school counselor may not be able to call you down to the office on the same day.  

If you have a quick question, please message your counselor on Schoology or via email.  Please be sure to check Schoology for responses.  If this is an emergency, please ask your teacher to see a school counselor immediately.
Email *
First Name *
Last Name *
Grade Level  *
Email Address *
Please provide an email address that you check as your question may be answered by email or Schoology. 
Select your Counselor *
Counselors are based on Last Name, unless you are in a Specialty Center. 
Reason to see counselor.. *
Required
Please share the specific reason for your meeting request  (ex: I am having a difficult time managing the workload in my classes.)
 *
*IMPORTANT NOTE - Please note that School-Based Mental Health providers are not available to provide guidance, resources, or intervention services for mental health emergencies outside of school hours. This form is not to be used for emergency situations and is only accessed during the hours of 9:00am - 4:00pm on school days. If you have an emergency please contact a trusted adult or use one of the emergency resources:

If you or your child are experiencing an emergency or crisis, please call 911 or go to your nearest emergency room for immediate assistance.

For additional mental health services, Henrico Area Mental Health may be accessed at the following numbers: 804-727-8515 (same day access) or 804-727-8484 (emergency). 

To report suspected child abuse or neglect, please contact Child Protective Services at (804) 501-5437  (Mon.-Fri., 8-4 pm) or the VA Child Abuse & Neglect Hotline outside of business hours at 1-800-552-7096.  

If you are experiencing or have experienced domestic/intimate partner violence, sexual violence, or human trafficking, please contact Safe Harbor’s 24 hour helpline at (804) 612-6126. 

Thank you,
JRT School Counseling
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