JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
El Dorado Parent/Guardian Counselor Request Form
Please complete the following questions below if you would like to discuss any concerns regarding your child in ensuring their best learning success while at El Dorado Elementary.
If this is URGENT due to a safety concern, you may contact the front office at (661) 942-8487 and request to speak with the school counselor- Mrs. West.
Sign in to Google
to save your progress.
Learn more
* Required
Parent/Guardian Name
*
Your answer
Student Name
*
Your answer
Student Grade
*
Your answer
Please provide your preferred contact number or email address to receive a response from the school counselor
*
Your answer
Week Days that Work Best for a Meeting (Please choose more than one)
*
Monday
Tuesday
Wednesday
Thursday
Friday
Required
Area of Concern (If other please provide a short description)
*
Academic Concern (Grades, Goal Setting, Organization, Time Management, or Study Skills)
Attendance Concern (School Refusal, Challenge 5, Attendance Letter, or Independent Study)
Crisis Concern (Self Harm, Threats, or Suicidal Ideation)
Emotional Concern (Sadness, Anger, Isolation, Trouble Sleeping, Anxiety)
Situational Concern (Death, Divorce, Separation, Deployment, Deportation, Homelessness)
Student Services Meeting (SST, 504, Crisis Follow Up, or IEP)
Social Concern (Bullying, Cyber-Bullying, Gang Affiliation, Peer Conflict)
Requesting Information about School Based Mental Health (SBMH) services
Other:
Required
Additional Information
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of LANCASTER SCHOOL DISTRICT.
Report Abuse
Forms
