Request To Meet w. School Counselor
Please fill out this form if you would like to meet with your School Counselor.
They will get back with you as soon as possible.


If you are experiencing a mental health or other type of crisis, please contact 911, or access the following resources:                                      
Cuyahoga County’s Frontline Services Mobile Crisis Team has a 24/7 hotline that can be contacted in the event of a mental health emergency.
The Mobile Crisis hotline is 216-623-6888.                                            
National Suicide Prevention Lifeline: 1-800-273-8255/ 1-800-273-TALK                                            
Crisis Text Line: 741741                        
United Way: 211                            
Rape Crisis Hotline (Call or Text): 216-619-6192 or 440-423-2020                        
National Youth Crisis Hotline: 1-800-442-HOPE                        
Berea Police Department: 440-234-1234                      
Brook Park Police Department: 216-433-1239                    
Middleburg Heights Police Department: 440-234-1234
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Email *
If this is an emergency, instead of filling out this form, please come to the Counseling Office and speak with Ms. Kronika, and she will put you in contact with an available counselor. (Some examples of emergencies are: you/friend are thinking about suicide, getting abused, currently under the influence of drugs or alcohol, going to physically fight/or know about a planned fight, physically injured in some way, having a mental health crisis, have information about weapon/danger in school building). *
Required
Last Name: *
First Name: *
Student ID Number *
Grade *
Who is the Counselor You Would Like To Meet With? *
What Type of Issue Do You Need Help With? *
Preferred Method of Communication with the Counselor: *
Email
Phone Number
I currently have a study hall / can meet: *
Required
Description / Details of Issue
Please do not include any kind of information you would like to keep confidential - All of the Counselors will have access to this form/information.
I understand it is possible that no one may see this request in the next 24 hours. If this is an emergency/crisis that needs to be addressed sooner than that, I understand I need to come to the Counseling Office in person or contact my counselor directly. (I also see there are emergency contacts listed at the very top of this form) *
Required
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