Counselor Request
The purpose of this form is to ensure timely assistance/intervention is provided to students. The goal is to provide a response to students by the next school day. However, scheduling and other incidents may cause a delay.

Situations of a CRITICAL nature should be followed by a phone call to the school counselor.

Person Making Request
Required
Teacher/Administrator Making Request
Name of Other Person or Parent Making Request (If applicable)
Your answer
Student First Name
Your answer
Student Last Name
Your answer
Grade Level
Required
Homeroom Teacher
How can the counselor help?
Required
Description:
Your answer
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