Request to See Counselor/Social Worker

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Welcome to PCMS Counseling Office! We are thrilled to assist you. To better meet your needs, please complete the form below. (This information is confidential.)

This is intended for non-emergency requests and should not be used in an emergency. Please allow up to 24 hours for a response.

First Name *

Last Name *

Grade Level *

6th Grade

7th Grade

8th Grade

I need to meet with: *

Ms. Schank (School Counselor, Last Names A-K)

Mrs. Edman (School Counselor, Last Names L-Z)

Mrs. Powers (Social Worker)

My request is about (this is confidential): *

Academic (classes, grades, attendance, etc.)

Social (Conflict with peers, bullying, etc.)

Emotional (Having a crappy day, feelings of depression, anxiety, etc.)

Other:

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