Counselor request form
Students please use this form to request a meeting with a counselor. We will get back to you as soon as possible. (This form is for student use only)
* Required
Email address
*
Your email
Todays Date
*
MM
/
DD
/
YYYY
Name (First and Last)
*
Your answer
Grade
*
6th Ms. Mehmen
7th Mr. Cole
8th Mrs. Yahner
Do you have a problem today?
*
Yes
No
Yes and it's urgent (someone or myself is in danger, or I am extremely upset about something)
What is it that you would like to talk about today? describe briefly
*
Your answer
How would you like to meet?
*
phone
in person
google chat
Google meet or zoom (video conferencing)
email
Phone number (only if you selected to speak by phone)
Your answer
A copy of your responses will be emailed to the address you provided.
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