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?
What is your ID number?
What grade are you in?
What is today's date?
Worried about school/grades
Worried about home/family
Having trouble with another student/friends
Having trouble with an adult
Needing a schedule change
Describe your problem here. Please include names of people and details if possible.
I need to see you...
For a check-in.
When you have time this week.
As soon as possible!
Email me, please. I prefer to chat with you through email.
What is your email address? (if you prefer to chat with a counselor through email)
Have you tried these things first? Check all the ones that you have done.
I tried to solve the problem myself first.
I tried to calm myself, walk away, and let it go.
I thought about it, and I think this will still be a problem tomorrow.
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