Counselor Request Form
Please complete this form to request an appointment with Ms. McPeek.
My last name is:
My first name is:
My Birthdate (dd/mm/yyyy) is:
My grade is:
I would like to see my counselor regarding:
My class schedule
An issue with peers
A family issue
A personal concern
Please tell your counselor a little bit about your reason to see the counselor.
How would you like to have your appointment?
If you selected a phone call, please provide a good number here.
Thank you for submitting your counselor request online.
Ms. McPeek will respond within a day or two, and she will contact you through your school email. If you selected a Google Meet or Zoom appointment, you will need to check your email for the appointment time and meeting information.
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This form was created inside of Valverde.edu.