Hixson Student Support Sign-up

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First Name *

Please enter in your first name.

Last Name *

Please enter in your last name.

Team Name *

Please select your team from the options below.

How are you feeling today?
*

I feel terrible.

I feel okay.

I feel good.

I feel great.

Reason for visit *

Please share with us the reason for your visit

Academic Support (grades, organization, study skills, test-taking, etc.)

Schedule Change Request

Stress/Anxiety

Peer Concern or Conflict

Basic Needs (snack, hygiene)

Report a safety concern

See Mrs. Goede (School Social Worker)

Requested support (check all that apply)
*

Use of Quiet Corner (time alone to regulate before returning to class)

Need a snack

Hygiene item

Check in with a counselor

Check out Self Care 1st Aid Kit

Check out Self Care Stuffed Animal

None of these

Required

If your Grade-Level Counselor is unavailable, would you like to visit with any available counselor? *

Yes, any available counselor is fine

No, I prefer to wait for my grade-level counselor to be available

Submit

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