Friona Elementary Counselor Request for Mrs. Rosales
Hello!  Before we meet, help me to better understand what you are experiencing  by filling out this form.  Mrs. Rosales will be the only one who can see your answers.

**If this is an emergency and you need help immediately, if you are thinking of hurting yourself or someone else, please find a trusted adult at home.**
Dear Mrs. Rosales, (this is optional)
Name (first and last) *
Date *
MM
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DD
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YYYY
Time *
Time
:
Grade *
Teacher *
How are you feeling today? *
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I need to talk to you about *
Required
This is a.. *
What coping skills have you tried before contacting Mrs. Rosales (check all that apply) *
Required
How is everything at home? *
How is it going with your school work? *
Do you need a check-in call? *
Is there anything else you would like to share?
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