Houston High School Counseling Request Form for Mrs. Sobotta
Please use this form to request a phone, virtual or in person appointment with Mrs. Sobotta. I will do my best to accommodate your request, or email you with an alternate time. You will receive an email at your HSD email or parent email listed in Campus with instructions for your appointment. Please reply to that email ASAP if you have questions or think you may need help joining a virtual counseling session.
Using technology to discuss personal and private matters does not ensure the same level of confidentiality as face to face encounters. I recognize that there are limitations and risks with online communication. Please review the "Virtual Counseling Informed Consent form" on Mrs. Sobotta's webpage for more information.
I have reviewed the Virtual Counseling Consent Form and recognize that there are limitations and risks with online communication
This form is for non-emergencies only. Threats to self or others should always be reported immediately to the counselor or an administrator. If you have immediate concerns for a child's safety and/or believe they are victims of abuse, please make a Child Protection report or call 911.
Please understand that confidentiality cannot be guaranteed in virtual meetings. Mrs. Sobotta will make every effort to ensure a confidential conversation, and as always if she is concerned you may harm yourself or others, or that someone is causing you significant harm, she will notify the appropriate persons.
Student first name*
Student last name*
Reason for needing to visit with Mrs. Sobotta
Having some friend issues
Stuff going on at home
Feeling sad, worried or stressed
Having a conflict with someone
Being bullied or harassed
Need help with school (grades, organization)
Question about my schedule
Question about high school/college/careers
I am worried about someone else who may need a counselor's help
The person completing this form is...*
Parent (I am a parent of a student at HHS or Summit LC)
Other (please list):
If you are a parent or a teacher/staff, what is your first and last name?
What type of appointment would you like?
Chat without video
Please list your preferred dates/times that you would like an appointment. You will receive an email confirmation with your scheduled appointment time. Mrs. Sobotta will email you a confirmation of your scheduled appointment.
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This form was created inside of Houston School District #294.