CHS Counselor Appointment Request

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In addition to the appointment sign-in sheet located outside our office, students may now request an appointment by completing the below information. As always, if urgent attention is needed, please contact us directly or contact the nearest teacher or school administrator.

Student Name: ( Last Name, First Name ) *

Please list your grade level for the 2020-2021 school year: *

9th Grade

10th Grade

11th Grade

12th Grade

Student Contact Info: Please list your email address, if you would like to be contacted by email:

Reason I need to see my Counselor: Check as many as you need below: *

Worried about something at home/family

Worried about school (classes, grades, graduation, ect)

Having trouble with another student(s)

Dealing with a personal problem

Need to discuss Program of Study, Academic or College/Career Plan

Other:

Required

Is your safety or the safety of others at risk because of this issue/problem? * *

YES

I'm not sure

Required

How much stress or worry is this problem causing you or others right now?? * *

Very little (it is okay to see me within a week)

A LOT (See me as soon as possible)

Submit

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