Counseling Request Form
***STOP!!! DOES YOUR TEACHER KNOW YOU ARE HERE? IF NOT, YOU MUST HEAD BACK TO CLASS AND RECEIVE PERMISSION
Please rate how urgent this situation is.
(1 - Just Wanted to Talk) ------- (3 = Upset / Need Help) ------- (5 = Emergency)
I Just Wanted to Talk
Please describe in detail (full sentences) the current situation.
What do you want in this situation? What is your goal?
What things can you do to make the situation better?
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?
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