School Counseling Request

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Appointment with Mrs. Ingalls

Email *

If you or someone you know is experiencing thoughts of suicide, self-harm or harm to others, please report directly to the school office for IMMEDIATE assistance during school hours or CALL 988 to talk to a caring, confidential person available 24/7.

First & Last Name *

Contact Phone Number *

I am a ___________ *

Student

Parent/Guardian

Teacher

Other:

What would you like to talk about? (check all that apply)

Class schedule

Academic issue

College/Career advising

Interaction/Problem with teacher(s)

Interaction/Problem with another student

I have a personal problem

Family concerns

More information regarding student enrollment

Other:

Is there anything specific you can share with me so I can be prepared for our appointment?

I need to see you or have you connect with me_____________ *

As soon as possible!

Sometime today

Sometime this week

Other:

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