Virtual/Phone Counseling During Covid 19
Dear Parents/Guardians,

If you would like your son/daughter to receive school counseling by Mr. Joseph DiPatri during this time please fill in the permission form below. Counseling sessions will be done via Google Meet or telephone. Please indicate your preference on the form below. Counseling sessions are individualized and depend on the needs of your child.

I look forward to working with your child and family during this time of uncertainty. Additionally, you can contact me at 856-456-7000, extension 3154. I will return all calls promptly.
Sincerely,
Joseph DiPatri, MA, M.Ed
Certified School Counselor
Email address *
Which method of counseling do you prefer? *
Child's First Name: *
Child's Last Name: *
Child's Grade Level: *
Teacher's Name: *
Preferred method of contact. *
If phone call, please provide the best phone # to reach your student: *
If Google Hangout, please provide best email address to receive the invitation for Google Hangout: *
Please provide best time of the day to contact your student: *
Your participation and voice are key components to the success of any counseling program. I value your input and would welcome any additional information regarding your child and family that you think would be helpful in meeting your child’s counseling needs. Please feel free to describe below any other information below that would be helpful for me to know. Counseling sessions and any information shared will be kept confidential. *
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Gloucester City Public Schools. Report Abuse