JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Lava Ridge Counseling Student Sign-in
Please fill out the form below and we will do our best call you down as soon as we are able. Visit our website at
counseling.lavaridge.net
for more information.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Student First and Last Name
*
Your answer
Which grade are you in?
*
6th
7th
What is your preferred contact information? (Phone number, email, etc?)
Your answer
Who would you like to see?
*
Mrs. Jesienouski (Mrs. J)-6th Grade Counselor.
Mr. Lounsbury-Decker (Mr. LD)-7th Grade Counselor.
Any Counselor
Are you feeling suicidal or are you reporting someone who is having suicidal thoughts or thoughts of harming themselves?
*
No
Yes-for myself
Yes-for a friend
What do you need from the counselors?
*
I need a class change.
I need a counselor for other reasons.
I was called down to see a counselor
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Washington County School District.
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report