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How can we support you?
Our school district strives to promote the health and wellness of our students, families, and communities. Use this form to request counseling or support services through your school district to get help with any problems or issues that you or someone close to you may be experiencing. Complete the form, click the submit button, and your request will be sent to a service coordinator who will contact you to schedule a meeting.
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Date Submitted
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Select your school:
Your Full Name
Your answer
Your Date of Birth
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YYYY
Your Phone Number (Optional)
Your answer
Your Grade Level
Your Gender
Your Race/Ethnicity
Required
Your Homeroom Teacher (Optional)
Your answer
Request Information
Reason(s) for Request: In two to three sentences, let us know what is going on with you.
Your answer
Is there someone you would prefer to speak with about the request?
Your answer
Submit
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