Counselor Request Form
Your Student Services team is here to support you! Please complete this form and someone from Student Services will be in touch with you.
6th Grade: Ms. Tersigni at
7th Grade: Mrs. Brownlow at
8th Grade: Ms. Yacobucci at
Social-Emotional Learning Specialist: Ms. Whipple at
If you or someone you know is in crisis, please dial 911, call the Colorado Crisis Hotline at 1-800-273-8255, or contact Safe 2 Tell at 1-877-542-7233 or
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to save your progress.
Name (First & Last)
I would like to talk to the counselor about:
Schedule: Missing Class or Incomplete Schedule
Schedule: Wrong Class Level
Schedule: Already Taken Specific Class
Schedule: Question about Class Placement
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This form was created inside of Jefferson County Public Schools.