Request for Counseling
We are still here to support you from home, please let us know how we can help.
What is your first and last name?
What grade are you in?
What area do you want support in?
Academic- help with school work or communicating with a teacher
College and Career
Would you prefer group or individual counseling?
Group- with other students
Individual- one-on-one check-in with counselor for about 30 minutes a week
How are you available to talk? - please check all that apply
Please check acknowledging we will ask your parent's permission to work with you while at home and how they want us to communicate with you
I know you will ask my parents' permission.
Confidentiality still applies. What you say to a counselor stays between you and the counselor unless someone is hurting you, you want to hurt yourself, you want to hurt someone else, or you give permission to tell. Please check the box acknowledging you are aware of the rules of confidentiality.
I read the rules of confidentiality.
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This form was created inside of San Diego Unified School District.