Student Wellness Services Request for Help
If you are experiencing a crisis or an emergency, dial 911, or go to your local emergency room.
For non-emergencies, please fill out this request form for assistance. We will process this request as soon as possible. Thank you!
The Student Wellness Services Request for Help will be processed in the order that requests are received. This may not be the same day. If this is an emergency please dial 911 or go to your local emergency room for immediate assistance.
Please enter the student's campus. If unknown, please select the Unknown option.
Ashbel Smith Elementary
De Zavala Elementary
San Jacinto Elementary
Victoria Walker Elementary
Cedar Bayou Junior
Horace Mann Junior
Goose Creek Memorial
Peter E. Hyland Learning Center
POINT Alternative Center
Robert E. Lee
Ross S. Sterling
Stuart Career Technical High School
Please select the student's grade. If unknown, please type Unknown.
Please enter the Student's ID number. If unknown, please type Unknown.
Please enter the Student's Last Name
Please enter the Student's First Name
Basic Needs (Food, Housing, Clothing)
Course Completion (course selection, credit recovery, schedule change, summer school, etc.)
College & Career (College, Career, Military Access, Financial Aid, ASVAB, ACT/SAT/PSAT, etc.)
In order to best assist you, please provide specific referral information, explain what help is being requested.
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Goose Creek CISD.