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Request to See Counselor
If you would like to talk with a counselor, please fill out this request form and Mrs. Smith or Mrs. McBride will call you out of class.
* Indicates required question
Email
*
Record my email address with my response
I would like to see:
Mrs. Smith
Mrs. McBride (Wednesdays and Thursdays only)
Either
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What is your first name?
*
Your answer
What is your last name?
Your answer
I would like to talk about
*
Home concern
School concern
Friend concern
I just want to talk
Other:
Is your problem urgent ("Urgent" means you are worried about your safety or the safety of others)
*
Yes
No
Not sure
Is there anything else you'd like to tell the counselor?
Your answer
Submit
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