2023-2024 Student Counseling Requests

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Use this form to request an appointment with your counselor. Your counselor will look at your schedule and will email you with an appointment time. This may not be the same day as your request so please allow them a whole school day to respond. If there is a safety concern, your counselor will meet with you as soon as possible.

THIS FORM IS ONLY CHECKED DURING SCHOOL HOURS. IF THIS IS AN EMERGENCY TALK TO A TRUSTED ADULT IMMEDIATELY.

Email *

Record my email address with my response

Last Name *

First Name *

My counselor is... *

Mr. Nikiper (LC1 / LC4 last names A-L)

Ms. Saunders (LC2)

Ms. St Lawrence (LC3)

Ms. Jones (LC 4 last names M-Z / LC5)

This is a... *

Peer Issue

Teacher Issue

Family Issue

Personal Issue

Schedule Issue

Required

Please write at least one sentence to explain why you want to speak to a counselor *

On a scale from 1 to 5, my problem is... *

1 (Not an emergency at all. Could wait a day or two)

2 (I am worried about this but I can wait)

3 (This problem is stressing me out and I'd like help soon)

4 (I am not in danger but this is a big problem and need to talk to someone soon)

5 (Me or someone else is in danger. Need to talk right away)

I understand that my counselor will get back to me within one school day and that this form does not guarantee a same day appointment. If I am in danger and need an adult right away, I will ask a trusted adult to call my counselor. *

I understand

Submit

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