Scholar's Social Worker Support Form
This form is designed for you to connect with the social worker to get help and support needed during this time of virtual learning.  

The information you share will not be discussed with others except when you are at danger of harming yourself, others, or is unsafe. Please read the confidentiality statement included in the email that had the link to this form. There you will find a detail explanation of confidentiality and ways to protect your privacy.

Social worker will be in contact with you via phone or email.  Zoom meetings can be scheduled.
Sign in to Google to save your progress. Learn more
Email *
First and Last Name *
Grade *
Phone number and Email address *
Why do you need support?                                         (Check all that apply to you) *
How are you feeling?                                                       (Check all that apply to you) *
Give a short summary of your situation and why you need support. *
Would you like the Campus Minister to connect with you for spiritual support? *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Holy Family Cristo Rey. Report Abuse