First and Last Name:
Please check the box(es) below that best describes your current needs for support:
Anger Management (how to handle your anger)
Coping Skills (how to cope with stress)
Grief and Loss (someone close to you died)
Healthy Ways (for example, if you have an unhealthy relationship with food)
Empowerment Group (for example, if you have been bullied a lot)
Self-Confidence Group (if you don't feel good about yourself and who you are)
None at this time
I have other areas of concern right now that I'd like to talk with my counselor about:
I am concerned about another student.
Please provide first and last name of the person you are concerned about, along with a brief reason for your concern:
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