Request for Student Counseling

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If you feel your student would benefit from visiting with me, that's great! I understand that it can be hard to reach out directly so feel free to fill out this form

Email *

Your name and relationship to student *

Can I contact you for follow up? *

Yes

Student's name *

Student's Grade *

Concern area *

Social (making friends, bullying)

Emotional (grief/loss, anxiety, acting out of character)

Academic (grades, outside opportunities)

Required

Feel free to leave any details here

Submit

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This form was created inside of State of South Dakota K-12 Data Center.