Submit a Request for Student Mental or Behavioral Health Services
Our school district strives to promote mental health awareness and access to mental health services in our schools to increase health and wellness of students, families, and the community. Please use this form to submit requests for counseling, support, or intervention services for any student experiencing emotional or behavioral concerns.

Please provide your email address below. You will have the option to receive a response receipt via email after you submit the form.

Email address *
Form1A
Date Submitted *
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Student Information
School: *
Student Legal Name (First and Last) *
For example: Elizabeth Johnson
Your answer
Student Date of Birth *
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Student Grade Level *
Student Gender *
Student Race/Ethnicity *
Required
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