Request to see the Counselor

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Request to see the Counselor

Mrs. Bryant or Mrs. Gastineau will meet with you within 48 hours of this form being filled out. If this is an emergency please go to the Counselor's Office.

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First Name: *

Your answer

Last Name: *

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Grade: *

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Reason to see the School Counselor: *

Friend Issue

Family Issue

Self Harm

Personal Issue

Schedule Question

Academic Concerns

Other

Can you give me any information now so I can be prepared to help you when I see you? (i.e. best way/time to reach you, specific information you want to know)

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