2022-23 Shoal Creek Counseling Request Form
Hello Shoal Creek families!

I look forward to assisting you as quickly as possible. Please answer the questions completely so that I could better assist you. Once you fill out this form, Ms. Nicolas will get in contact with you. Thank you for your counseling referral.  

CONFIDENTIALITY DISCLOSURE: Information shared on this form is seen by the site counselor and will not be shared with anyone UNLESS you disclose safety concerns.
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Parent/Guardian Email Address: *
Student's Full Name: *
What grade is your student in?
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How would you like to be reached? *
Who is your student's teacher?
What is your child struggling with currently? *
This is a:
Clear selection
Is there anything else you would like to share with Ms. Nicolas?
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