School (Guidance) Counselor Appointment Request Form
In order to schedule an appointment with your School (Guidance) Counselor, please complete the form below. Please be as specific as possible, so your counselor can respond appropriately.
PLEASE NOTE: If you are experiencing a medical emergency, have taken an overdose, or have harmed yourself in any way, DIAL 9-1-1 IMMEDIATELY
If you are having a psychiatric or substance abuse crisis and need assistance, please contact Mobile Crisis Intervention Services (MCIS): Northern Delaware Hotline, call: 800-652-2929
* Required
Student First Name
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Your answer
Student Last Name
*
Your answer
I am a Christiana
*
Choose
Student
Parent/ Guardian
If Parent/ Guardian: First and Last Name
Your answer
Email address:
*
Your answer
Best Phone Number You Can Be Reached
*
Your answer
Grade
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Choose
9
10
11
12
6
7
8
Counselor (if known)
*
Choose
Habbert (Students in Honors Academy, 6th -12th)
Rumley (Students Last Names A- G)
Donaldson (Students Last Names H- N)
Nersasian (Students Last Names O- Z)
Select the Reason for Appointment (leave the details below).
*
Choose
Schedule change Fall 2020 Semester (before 9/28)
Schedule change for Spring 2021 Semester
Academic concern
Personal concern
College information
Details about appointment.
*
Your answer
Submit
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