Student Counselor Assistance Form
Students who would like assistance from a counselor can complete this form, and Mrs. Salinas, Mrs. Escamilla, or Mrs. Knight will see you or respond to you as soon as possible.
What is your first AND last name? *
Your answer
What is your ID number? *
Your answer
What grade are you in? *
Homeroom Teacher? *
Your answer
What is today's date? *
MM
/
DD
/
YYYY
I am... *
Required
Describe your problem here. Please include names of people and details if possible. *
Your answer
I need to see you...
What is your email address? (if you prefer to chat with a counselor through email)
Your answer
Who do you want to talk to? *
Submit
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