Gordon-Reed Student/Parent Counseling Referral Form
Welcome to our online virtual counseling request form. This form is a communication tool for  students and/or parents to address any needs that may occur during our physical absence of school. Please fill out the form in it's entirety so that we can get in contact with you as soon as possible. If you are a parent, Once the form is submitted, we will then send you a confirmation email with your appointment time and the tool we will use to communicate.
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Email *
Phone Number
Please indicate if you are a student or parent: *
Student Name- ( 1 Form per child only ) *
Homeroom Teacher *
Parent Name *
Please share what you would like to discuss *
Required
If you chose "Other" please type your concern
How important is your need to speak to me? *
Thank you for filling out our form! We will get back with you as soon as possible!

 Mrs. Wright
Mrs. Ballew
AGR School Counselors
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