I Want to See Mrs. Reynolds, My School Counselor!
READ THIS CAREFULLY: This is the Online Student Referral Form to see Mrs. Reynolds.   You only need to fill out one referral form per day per issue. 

All referrals will be kept confidential unless someone may get hurt.  DO NOT use this form for EMERGENCIES (as in, someone threatening you, abuse, thinking about self-harm). If someone is threatening you, please see your teacher or an MMS administrator as soon as possible. If you are completing this form after school hours and you have an emergency, please talk to an adult you can trust IMMEDIATELY!!! If this is a crisis, you may text the National Crisis Text Line 988.

DO NOT USE THIS FORM FOR SCHEDULE/CLASS CHANGE REQUESTS. 

Email *
Today's Date: *
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Student's First Name: *
Student's Last Name: *
Name of Your Homeroom Teacher: (your homeroom teacher's name below) *
I need help with: *
Required
Give a brief description as to why you need to speak with Mrs. Reynolds: *
Have you told a parent or guardian about your issue? *
Please check the coping strategies you will use until we can talk:
 *
Required
You can see me:  *
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