RSMS Student Counselor Assistance Form
If you would like assistance from a Counselor or Mrs. Salinas, please complete this form. Once you submit the form either Mrs. Knight, Ms. Fairley, or Mrs. Salinas will schedule a time to meet with you as soon as they can.
What is your first and last name?
What is your ID number?
What grade are you in?
What is today's date?
I am...(check all that apply)
Worried about school/grades
Worried about home/family
Having trouble with another student/friends
Having trouble with an adult
Needing a schedule change
Describe your problem here. Please include names of people and details, if possible.
I need to see you...
For a check in.
When you have the time this week.
As soon as possible!
Email me, please. I would like to be counseled through email.
What is your email address (if you prefer to chat with a Counselor through email)?
Who would you like to meet with? (Choose 1)
Mrs. Knight, 5th grade Counselor
Ms. Fairley, 6th grade Counselor
Mrs. Salinas, Social Worker/Counselor
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service