Form to See the Counselor
Please fill in the form, and Mrs. Zubillaga will connect with you in the next 24 - 48 hours.
* Required
Your Name
*
Your answer
Your Email Address
*
Your answer
Name of the Person to See the Counselor
*
Your answer
Teacher's Name (if applicable)
Your answer
Grade Level or Other
*
Choose
Preschool
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
Other
Reason for Seeing the Counselor
*
School
Home
Friendship / Peer Issue
Schoolwork
Choices / Habits
Other:
Is this Urgent?
*
Yes
No
Not Sure
Other:
Additional Information You'd Like the Counselor to Know (optional):
Your answer
In Case of Emergency or Safety Concern
If you or another person is presenting an immediate risk of danger to yourself or others, call 911. You may also call 911 to request a wellness check if you are unsure of your or another person's current safety.
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