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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