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)
Name (First and Last)
6th Ms. Mehmen
7th Mr. Cole
8th Mrs. Yahner
Do you have a problem today?
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
How would you like to meet?
Google meet or zoom (video conferencing)
Phone number (only if you selected to speak by phone)
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Jefferson County Public Schools.