MNTMS Parent - Counselor Request
This form is used to request and give consent for you or your child to speak with their counselor about issues regarding academic and/or social-emotional well-being. Note: This form is not monitored 24/7 and should not be used in case of an emergency. If you or someone you know is experiencing a mental health emergency, please call 911.
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Email *
Virtual Office Hours
10:00 - 11:30 am
1:00 - 2:30 pm

Counselors will reach out within 24 hours of your request. Monday through Friday.
Parent's First & Last Name
Scholar's First & Last Name
Scholar's Grade Level
Student ID Number
Phone Number
Preferred Contact Time
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Reason for Counselor Request
So that we can better support you, please provide a brief description about your reason for submitting a counselor request. *
By typing my full name into this document, I am consenting for my child to speak with their counselor over the phone from today's date through the end of the school year. I understand the role of the school counselor and the limits of confidentiality. I will email the school counselor if I have questions or concerns regarding my scholar's phone conversations.
Today's Date
MM
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DD
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YYYY
A copy of your responses will be emailed to the address you provided.
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