Ms. Smith, Counseling Appointment Request Form

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Adresse e-mail *

If this request is related to a risk of harm to myself or if I am concerned about a peer's harm to self or harm to others, I will notify a staff member immediately or if I am not on campus I will call 911 or 988 (the suicide and crisis emergency line)
*

I agree to the statement above

Obligatoire

First Name: *

Last Name: *

Grade *

9th

10th

11th

SENIOR!

Which counselor would you like to meet with? *

Ms. Szilagyi- 9th Grade

Ms. Smith- 10th Grade

Ms. Waller- 11th Grade

Ms. Chargualaf- 12th Grade

Ms. Kellison- College, Career, Exchange Students and New Seniors

Ms. Weinsheimer- Mental Health Counselor

Ms. Cushway

Mr. Keck

Ms. Dahl- Registrar, Transcripts

Schedule my appointment *

When convenient

As soon as possible

It's an emergency (reminder: if you feel that you are a risk to yourself or others notify an adult immediately or call the crisis line at 988 or 911)

My request pertains to... *

Academic/ Scheduling

Peer or Teacher Conflict

Mental Health

College/ Career

Other

Reason/ Concern (for scheduling inquiries please be specific) *

Don't forget to check your student email for communication from your counselor! *

I have read the statement and will check my student email.

Obligatoire

M'envoyer une copie de mes réponses

Envoyer

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