Faiss Flyer Academic/Counseling Assistance Form

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Use this form if you need to see your counselor, safe school professional, or behavior strategist. Once you submit the form, a staff member will call you to the approprite office or will send a response to your CCSD gmail account within 48 hours.

This form is not monitored outside of school hours. If you or someone you know is in danger from self or others, please do not fill out this form. You should immediately talk to a trusted adult, call the Suicide Prevention Lifeline at 988, call 911, or go to the nearest emergency room.      

Email *

STUDENT FIRST Name *

STUDENT LAST Name *

Student Number *

Person Requesting Contact *

Parent/Guardian

Student

After submitting this form, a staff member may email you a response rather than call you down to the office, particularly if it is a schedule change that cannot be done.

If you have not been called to the office within two school days, check your school email for a response.

Respond YES to indicate you have read and understand this.

YES

Staff assistance needed for a concern with: *

a class / schedule

another student

a teacher

my family

a friend

resources needed (food/clothing/basic needs)

Other:

Briefly explain your concern. *

Parent/Guardian - Best Phone Number / Email

Send me a copy of my responses.

Submit

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