Request to See My Counselor Form
Please fill out this form to meet with your counselor. We will call you in as soon as we can. If this is an emergency or crisis, make sure to let your teacher/s or another safe adult know. 
Email *
Todays date *
MM
/
DD
/
YYYY
First Name / Primer Nombre
 *
Last Name / Apellido *
Student ID# / Numero de ID *
Grade / Grado
 *
Counselor/ Consejero *
I need help with: / Necesito ayuda con:
 *
Required
I would like us to talk... / Me gustaria que hablemos
 *
Any additional comments? / Comentarios adicionales 
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