Belleville East Counselor & Social Worker Request
This link is for students or parents of a student that may be struggling academically or emotionally and would like to be connected to a counselor or social worker.


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Email *
Please share your name and your student's name if you are a parent/guardian. *
Which Campus do you or your child attend? *
What kind of support do you need? *
Required
Please check each staff member that you would like to talk to. *
Required
What's the best way to contact you?  Please leave detailed instructions.  Example: Please contact me on my cellphone. (618) 555-0201 *
Please leave a brief description of your issue or question so that we may best help you. *
After submitting this form someone will contact me within 24 hours during the school week (Mon- Fri, 8:30AM-3:30PM). If it's an emergency I know to dial 911.  I can also contact The National Suicide Prevention Hotline at (800) 273-8255, text the Crisis Text line at 741741, or connect with someone at www.suicidepreventionlifeline.org.  I also know that I can talk to a parent, guardian, or trusted adult if I'm in need of more immediate help. *
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