Student Counselor Assistance Form
Students who would like assistance from a counselor can complete this form, a Counselor or CIS Coordinator will connect with you as soon as possible.
What is your first AND last name? *
What is your ID number? *
What grade are you in? *
Homeroom Teacher? *
What is today's date? *
MM
/
DD
/
YYYY
I am... *
Required
Describe your problem here. Please include names of people and details if possible. *
I need to see you...
Clear selection
What is your email address? (if you prefer to chat with a counselor through email)
Who do you want to talk to? *
Submit
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