Counseling Request Form
***STOP!!! DOES YOUR TEACHER KNOW YOU ARE HERE? IF NOT, YOU MUST HEAD BACK TO CLASS AND RECEIVE PERMISSION
Your Name *
Your answer
Grade *
Please rate how urgent this situation is. *
(1 - Just Wanted to Talk) ------- (3 = Upset / Need Help) ------- (5 = Emergency)
I Just Wanted to Talk
Emergency
Please describe in detail (full sentences) the current situation. *
Your answer
What do you want in this situation? What is your goal? *
Your answer
What things can you do to make the situation better? *
Your answer
We have the chance to learn from everything that happens to us, good and bad. What are you learning as you process through this situation? *
Your answer
Submit
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