Request Form for District Secondary Guidance/Counseling Services
School Year Ending June 2020

The State of Minnesota has authorized local public school districts to allow pupils attending a nonpublic school, (includes home schools), established and operating within the school district boundaries, access to the existing district Secondary Pupil Guidance and Counseling Services program. These services must be requested by, or on behalf of, the pupil no later than September 15, 2019.

***Please check 'YES'. This allows us to accept government funded counseling services such as our Guidance Counselor. Please note that personal and spiritual counseling will remain in house.

Student's First Name *
Your answer
Student's Last Name *
Your answer
Grade Level *
Name of School *
Request for District Secondary Guidance/Counseling Services *
Parent Signature
I have agreed to submit this form by electronic means. I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature. *By typing my name below, I am electronically signing my form.
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Your answer
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