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
1-800-273-8255

(Spanish) National Suicide Prevention Hotline
888-624-9454

Crisis Text Line
Text ‘HOME’ to 741-741
Student Last Name *
Student First Name *
Student ID *
Student Phone Number *
Student Email Address (either school email or personal) *
Student Grade Level *
Reason/s for needing to see your counselor *
Required
If you need college/career help, do you need to speak with Mrs. Carnes?
Clear selection
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. *
Submit
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