Parent/Guardian Request Form
Hello LAVA Families!
Do you need to talk to Mrs. Duncan?
Please feel free to fill out this form and share with us how you are doing and what you need help with.
Your responses will be sent to our email and will be kept private. We look forward to hearing from you.  

LAVA: Counselor Website  
District: Lancaster's Counseling Department Website
My office hours are Monday-Friday from 7:30am-3:45pm
I will reach out to you as soon as I am able.

⭐Reach for the Stars⭐

Sign in to Google to save your progress. Learn more
What is your student's name? *
Your name please? *
What Grade is the student in? *
TK
K
1st
2nd
3rd
4th
5th
6th
7th
8th
My Student(s) Grade:
Best form of contact?
(Please make sure your contact information is updated in PowerSchool or we will not be able to reach you.)  *
Required
Best time to reach you?
(We will make every effort to meet your request) *
Early Morning (7:30am-10:30am)
Early Afternoon (11:00am-1:00pm)
Late Afternoon (1:30pm-4:00pm)
First Choice
Second Choice
Just a few questions...
*You are not required to fill out each column*
(Please check the appropriate boxes)
Yes
No
Good
Meh
Bad
I want to talk about this
I'd like more information
How are you doing?
Do you have an academic concern?
Do you have an attendance concern?
Do you have an emotional concern?
Is this a crisis concern?
Have you met our parent ambassador?
Are you requesting a Mental Health Referral?
Do you need help finding Community Resources?
Please provide a brief statement of your concern or request. 
(Please note, counselors are not able to change your students class. If you are looking to make that request. Please talk to one of the LAVA Principal.) *
Available Counseling Services to LAVA Students
I am available Monday-Friday 7:30am-3:45pm and I am generally off campus by 4pm unless needed in the event of an emergency or after school meeting.
Elementary and Middle School Students have the ability to request to talk to the counselors through a digital form found on our website and potentially also located in their Google Classroom's ( Dependent on the Teacher adding the link for their students)

LAVA School Counselors' Provide:
+ Academic, Social, Emotional, Mental, Transitional Grade Level, and College/Career Services
+ Guidance Lessons that are data driven
+ Small Groups for targeted behaviors or skills
+ Lunch Bunch Groups
+ Check-In Check-Out System
+ Crisis Counseling
+ Resource Connections
+ Outside Mental Health Referrals

*Parental/Guardian Consent is required for a student to participate in Small Group Counseling Services and Long-term Individual Counseling.
Learn more about:
*You are not required to fill out this section*
(Please check the appropriate boxes)
Small Group Counseling Available
Lunch Bunch Social Groups
Check-in Check-out
Resources available to me
Mental Health Agencies
Foster Youth Resources
Homeless Resources
I would like more information about:
**Important Information** 
If this is an emergency (abuse, self harm, suicidal thoughts/attempts, threats), do NOT email your School Counselor. Call 911 or text HOME to 741741 or call the National Suicide Prevention Line: 1-800-273-8255. There are more resources available on our website: "Need Help Now"

LAVA: Counselor Website  
District: Lancaster's Counseling Department Website

Please understand that confidentiality cannot be guaranteed via phone conferences or through all virtual settings. We will make every effort to ensure a confidential conversation can take place.

Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of LANCASTER SCHOOL DISTRICT.

Does this form look suspicious? Report

Google Forms