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.
First and Last Name
Student ID Number
6th Grade - Mrs. Mouton
7th Grade - Mr. Kerguelen (Mr. K)
8th Grade - Mrs. Johnson-Pearson (Mrs. J-P)
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?
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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This form was created inside of Spring Independent School District.