WELLS MS COUNSELOR REQUEST FORM
In order to communicate with your School Counselor, please complete the questions below. Please allow your School Counselor at least 24-hours to respond.
Email address *
First and Last Name *
Student ID Number *
Grade/Counselor *
Where are you right now? (ex. home, work, friends, etc?) *
Is someone home with you right now? *
If there is someone home with you, please identify the person/people with you now. (ex. mom, dad, friend, etc.)
Are you physically safe right now? *
What would you like to talk to your counselor about? *
Required
Please provide additional details about your concerns.
Please provide a phone number where your School Counselor can reach out to you.
Which method of contact would you prefer that your School Counselor reach out to you regarding this matter? *
A copy of your responses will be emailed to the address you provided.
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