MBES Counselor Request Form

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MBES Counselor Request Form

Bobcats, complete this form to ask to speak with your counselor. We will respond within 24 hours (1 day). If it is a weekend or holiday, we will reach out to you the next school day. We will also be in touch with your parent/guardian in order to set up a meeting with you.

If this is an emergency, please go to the nearest adult that you trust for help.

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Email *

Your Name (First and Last) *

Today's Date *

MM

/

DD

/

YYYY

Your Teacher *

I need help with (check all that apply): *

My feelings

A Friend/Other Kids

School

Family/Home

Something else

Required

If you checked "something else," explain here.

My problem is... *

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An emergency (immediately go to the nearest adult that you trust for help)

A big problem

A medium problem

A small problem

I have decided to:

try to solve this problem on my own.

request a meeting with my school counselor. (Your counselor will schedule a meeting with you.)

Clear selection

Send me a copy of my responses.

Submit

Clear form

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