Counselor Sign-In
Use this form to contact a counselor to discuss Roseville Adult School's high school completion programs (high school diploma, as well as GED and HiSET test preparation).
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This sign-in form is for use by members of the Roseville Adult School community who wish to receive a follow-up call/email/appointment from a counselor. This form is NOT intended to be used in the event of an emergency. PLEASE NOTE: If you or someone you know is in a LIFE-THREATENING SITUATION or experiencing a mental health crisis or emergency, please stop completing this form and CALL 911 IMMEDIATELY. ------------------------------------------------------------Este formulario de registro es para que lo usen los miembros de la comunidad de la Escuela de Adultos de Roseville (Roseville Adult School) que quieren recibir una llamada o correo electrónico o cita con un consejero. No se debe usar este formulario en caso de emergencia. aviso: Si usted o alguien que conoce se encuentra en una SITUACIÓN QUE PONE EN PELIGRO SU VIDA o que experimenta una crisis de salud mental o una emergencia, deje de completar este formulario y LLAME AL 911 DE INMEDIATO. *
Required
Last Name/apellido *
First Name/Nombre de pila *
Phone number/número de teléfono *
Email/correo electrónico
Reason for appointment request/Motivo por la consulta *
Required
Would you be most interested in classes during the DAYTIME (9am - 5pm) or EVENING (5pm - 9pm)? / ¿Cuándo le interesa más las clases? durante el día (9am a 5pm) o durante la tarde (5pm a 9pm) *
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