Counselor Request Form
If this is an emergency please dial 911. If you need to speak with someone immediately for suicide prevention please call the suicide hotline at 1-800-273-8255, or for other problems you can call the Texas Youth Hotline for advice at 1-800-989-6884 or text 512-872-5777.
Your name
Student ID *
What do you need to talk to the counselor about *
How big is the concern *
BRIEFLY explain what you are requesting a counselor for
If URGENT (EMERGENCY) briefly explain (examples could be thoughts of hurting self/someone else, wanting to fight, heard about a possible fight, bullying etc.) Something that cannot wait and is keeping you from staying in class.
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