Counselor Request Form
If you need to see your counselor (Mrs. Ditterline - last names A-K or Mrs. Rotter - last names L-Z). Please complete the form and submit it. Your counselor will call you down as soon as they are available.
Email address *
First Name: *
Last Name: *
Date:
MM
/
DD
/
YYYY
Grade Level:
Clear selection
Reason for needing to see the counselor: *
Required
Is this an emergency? An emergency is when you or someone you know is in immediate danger.
Clear selection
If this is an emergency, please give more information about what is going on.
Is there any other information that we should know before we call you down?
Submit
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