Contact Your Student's Counselor

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please fill out the following form to notify Mr. Haupt or Mrs. Haney of a student concern.

If this is an emergency please do not use this form. Call the Mobile Crisis Team at 1-855-634-4673 or access the Montgomery County Children’s Crisis Support Program which provides immediate support for crisis situations, and assistance with managing recurring or future crises. Support is available 24 hours a day, 7 days a week at 1-888-HELP-414.
.

Email *

Date: *

YYYY

Name (person submitting the form): *

Student Name: *

Grade: *

6th

7th

8th

Intended counselor: *

Mr. Haupt- All students with the last name A to K in grades 6 to 8

Mrs. Haney- All students with the last name L to Z in grades 6 to 8

Required

Area of concern: *

Academic

Social/Emotional

Other

Required

Please provide a brief description of your concern: *

I would like to schedule a Zoom/Google Meet time with the counselor! *

Yes

Or....the best number to reach me at is:

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Upper Moreland School District. Report Abuse

Forms