Parent Counseling  Request Form
Please use this form to contact the NMS Counseling office. 
Sign in to Google to save your progress. Learn more
Email *
I would like my child to meet with the counselor who would act as an advocate and counselor for an issue related to their academics, behavior, and/or social-emotional support. Kindly agree to the clause and mark your initials below *
My child could be emotionally charged during or post the sessions and I assure to assist the counselor in handling the emotions carefully when requested. *
I take complete responsibility for the changes my child seeks through the counseling process. With respect to this change, I assure the child to finish any home activities suggested by the counselor. *
The counselor can breach the confidentiality only at the time of any voluntary or involuntary threat to my child’s life. *
When does your child need to be seen? *
Briefly state any concerns or needs of your student. *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Northumberland County Public Schools. Report Abuse