Complete this form to contact Mrs. Eileen Klima, Student Assistance Counselor
Mrs. Klima will review responses several times a day Monday- Friday from 8:15 to 3:30pm and contact you as soon as she is available. Please understand she may be helping other students and families and may not be able to respond immediately.

Mrs. Klima's hours are Monday- Friday from 8:15 to 3:30.

If you need immediate support, please call one of the support systems below:

Emergency Services 911
Suicide Prevention Lifeline 1-800-273-8255
Humboldt Suicide Prevention (707) 268-2132
Humboldt County Mental Health (707) 445-7715 or 1-888-849-5728
United Indian Health Services Youth Suicide Prevention (707) 825-5060
Two Feathers (707) 839-1933
The Trevor Project LGBTQI Support 1-866-488-7386
North Coast Rape Crisis Team (707) 445-2881
Runaway Safeline 1-800-RUNAWAY or text 66008

Mrs. Klima recommends parents, families, and students read the short pamphlet DISASTERSHOCK HOW TO COPE WITH THE EMOTIONAL STRESS OF A MAJOR DISASTER at https://www.usfca.edu/sites/default/files/education/disastershock_manual_2017_b_final.pdf
Please type the first and last name of the student who needs support below. *
Who is making this referral for support? *
If someone OTHER than the student is completing this form, please put your first and last name and your contact information below.
What is the student's contact information? Please put the best contact information below whether it be an email and/or phone number. *
Please explain why you are contacting Mrs. Klima below. How may she support you or another student right now? *
Submit
Never submit passwords through Google Forms.
This form was created inside of Northern Humboldt Consortium of Schools. Report Abuse