STEM Lab Counseling Request Form
Please submit this form to request a meeting with Mr. Wiske or Ms. Decker.

DO NOT COMPLETE THIS FORM ON BEHALF OF ANOTHER STUDENT. This should be completed only if YOU want to talk.

Please note: this form will NOT be monitored outside of school hours.

If someone is in danger, and you are not able to sign up for a meeting with a counselor, please let an adult at home know AND fill out a Safe2Tell form at safe2tell.org.
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Email *
Today's Date *
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Who is requesting this meeting? *
Student Name (Last, First) *
Grade *
How soon do you need someone to check in with you? *
REMEMBER: If you mark that this is an emergency and someone is not able to see you within 30 minutes of your sign up, we would like you to tell your teacher (or another nearby adult) that you are worried for someone's safety.
Who would you prefer to speak with? *
Give a brief description of what you want to talk about. *
Submit
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