Student Counselor Assistance Form
Students who would like counselor assistance can complete this form, and Mrs. Salinas, Mrs. Escamilla, or Mrs. Knight will see you or respond to you as soon as possible.
What is your first and last name? *
Your answer
What is your ID number?
Your answer
What grade are you in? *
Homeroom Teacher? *
Your answer
What is today's date? *
I am... *
I need to see you:
What is your email address? (if you prefer to chat with a counselor through email)
Your answer
Give us a short summary of the problem you are having or what you need help with: *
Your answer
Have you tried these things first? Check all the ones that you have done.
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