Counseling Form (2025/2026)

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Hello!

Complete this form if you would like to meet with Mrs. Wemhoff.

Just a reminder that all conversations you have have with me are private and confidential; however, if there is a safety risk, some of the information that you share with me, will likely need to be shared with administration.

Email *

Record my email address with my response

Student Name: *

Grade Level: *

Warrior Time Teacher *

Reason for wanting to meet?

*Check all that apply!

I am having trouble with friends or peers.

I am feeling sad, angry, or upset.

I am struggling with schoolwork or motivation.

I have problems at home.

I want to talk about my future or goals.

I just need someone to talk to.

My friend needs help.

Required

How soon do you need to see me? *

I need to see you as soon as possible!

I can wait a couple days.

This is not urgent.

When would be a good time to meet with you? *

Before school (7:45 am)

During class (must have teacher permission, Mrs. Wemhoff will communicate with your teacher)

Lunch time

After school (3:45 pm)

Required

Is there anything else you would like to share about why you would like to meet with me? *

Submit

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