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.
Sign in to Google to save your progress. Learn more
Email *
Todays Date *
MM
/
DD
/
YYYY
I am a *
Student's name (First and Last) *
Grade *
Do you have a problem today? *
Is this a scheduling issue? *
What is it that you would like to talk about today? If it is a schedule change request please let us know the class exploratory class you would like to change and your top 3 exploratory classes that you prefer to have on your schedule. For non-emergent issues, we will try our best to get back to you within one business day. *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Jefferson County Public Schools. Report Abuse