Counseling Request Form
Fill out this form as completely as you can. Once you submit the form, a counselor will be in touch with you as soon as possible!
If you need immediate medical assistance, please call 911.
National Suicide Prevention Hotline
(Spanish) National Suicide Prevention Hotline
Crisis Text Line
Text ‘HOME’ to 741-741
Student Last Name
Student First Name
Student Phone Number
Student Email Address (either school email or personal)
Student Grade Level
Reason/s for needing to see your counselor
Academic needs (grades, schedule changes, AP/Dual Credit)
Mental health needs
If you need college/career help, do you need to speak with Mrs. Carnes?
Rate your situation on a scale of 1 to 5, with 1 being a non-emergency and 5 being a big emergency.
Not an emergency - I just need to talk
Huge emergency - I might need medical attention
Briefly describe what you are seeking to accomplish by speaking with your counselor.
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This form was created inside of Tyler Independent School District.