NormanAid Counseling Appointment Request
Please answer the following questions. Your responses are private and will only be seen by NormanAid Counselors (NOT Peer Counselors). We will respond to requests with a summons as quickly as possible. For additional resources, visit
normanaid.org
. To make an anonymous report, visit
normanonymous.org
.
*Please wait for your summons.
*IF YOU HAVE AN EMERGENCY OR A CRISIS, PLEASE VISIT YOUR SCHOOL COUNSELOR AND THEY WILL HELP YOU FIND IMMEDIATE SUPPORT.
* Required
First name, last name initial
*
Your answer
Student ID (long or short)
*
Your answer
Which period(s) do you believe your teacher would permit you to leave for an appointment?
*
1st
2nd
3rd
4th
5th
6th
lunch
Required
Do you have an emergency or a crisis and need to be seen immediatly? If yes, PLEASE see your school counselor so they can help you get immediate support.
*
Yes
No
Maybe
Please provide a cell phone or email so we can contact you if we have a question.
Your answer
Please share briefly your main reason for requesting an appointment.
*
Academics/college
Friendship/relationship
Mental Health: stress, anxiety, depression, etc.
Bullying/harassment
Grief or loss
Other:
Required
Have you met with a NA counselor before?
*
Yes
No
Are you assigned to a NA counselor for weekly appointments?
*
Yes
No
Have you met with a NA counselor already this week, or are scheduled for an ongoing appointment later in the week? (If yes, you will need to request a lunch appointment becasue students can only be excused to be in NA one time a week.)
*
Yes
No
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