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? *
Your answer
What is your ID number? *
Your answer
What grade are you in? *
Homeroom Teacher? *
Your answer
What is today's date? *
MM
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DD
/
YYYY
I am...(check all that apply) *
Required
Describe your problem here. Please include names of people and details, if possible. *
Your answer
I need to see you... *
What is your email address (if you prefer to chat with a Counselor through email)?
Your answer
Who would you like to meet with? (Choose 1) *
Submit
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