Parent Referral-Counselor, I need help with...
A School Counselor is available for students, parents, faculty, and staff by appointment. Once we receive and review the completed form, someone will be contacting you for more details. Please feel free to contact a school counselor at 662-280-7075.

Students with last name A-J, please contact Ms. Burchfield
Phone Extension: 117
Email: bernadad.burchfield@dcsms.org

Students with last name K-Z, please contact Mrs. Davis
Phone Extension: 113
Email: kim.davis@dcsms.org

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Child's First Name *
Child's Last Name *
Student's Grade Level *
Your First & Last Name: *
Your phone number or email. *
If not a parent/guardian, please indicate your role.
Please check the topics below that are causing the most difficulty *
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Describe your observations/concerns below/ *
Have you communicated your concerns with the teacher? *
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Actions taken by teacher to address concern:
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Would you like the teacher to contact you to schedule a parent conference? *
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