2020-2021 JAY SEA Request to See Counselor Form
Please complete the following questions to request a meeting with your counselor. We strive to respond to requests within 48 hours.
Call 911 if you are having thoughts of hurting yourself or others or know of someone who is having these thoughts.
Email address *
Grade Level *
Campus *
Student ID (the number you use for your lunch account or to check out a book) *
Email address *
Telephone number *
Student's Last Name *
Student's First Name *
Type of Concern *
Name of person completing this form and your relation to the student (write "self" if you are self-referring) *
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