Request for Counseling
We are still here to support you from home, please let us know how we can help.
Email address *
What is your first and last name? *
What grade are you in? *
What area do you want support in? *
Would you prefer group or individual counseling? *
How are you available to talk? - please check all that apply *
Required
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 *
Required
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. *
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