Request to See My Counselor Form

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Request to See My Counselor Form

Please fill out this form to meet with your counselor. I will call you in as soon as I can. If this is an emergency or crisis, make sure to let your teacher/s or another safe adult know.

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* Indicates required question

First and Last Name *

Your answer

Grade *

5th Grade

6th Grade

7th Grade

8th Grade

I would like to talk about... *

Academics: grades, gpa, classes, etc

Social-Emotional: myself, friends, family

Something else

Any additional comments?

Your answer

I would like us to talk *

Today

Some day this week

Submit

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