Counselor Request Form (To Schedule Appt Only)
If you feel your child needs to speak to a counselor, please complete this form to request an individual counseling appointment with Ms. Cantu or Mrs. Koeneke. You can use this form at any time throughout the year as your child's needs may change. Please allow 24 hours to be contacted by our Counseling Department for an appointment.  IF YOU OR YOUR CHILD ARE IN IMMEDIATE DANGER, PLEASE CALL 911.
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Email *
Name of student being referred (First and Last Name) *
Grade *
Homeroom Teacher *
What is the reason for the referral? *
Which counselor would you like to see? *
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