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Counselor referral form for Sierra Students
Please complete this form to be seen by your counselor.
* Indicates required question
Email
*
Record my email address with my response
Name
*
Your answer
Type the name of your teacher or room #
*
Your answer
Find your counselor
*
Mrs. Wendey- Grades 1/3/5, CUBS- Ms. Nations, UTK- Mrs. Atkins
Mrs. Lika- Grades K/2/4, CUBS-Mr. Hawkins, UTK- Mrs. Carla
Pick your weather emoji-feeling
*
I am feeling sad, please see me today or tomorrow.
I am feeling mad/angry, please see me by the end of the day
I am confused/frustrated, please see me within a week
I need help to resolve a conflict
*
If you need to talk it out, type the name of the student(s) below and short description
Your answer
Submit
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