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Schedule an Appointment with Ms. Manley School Counselor
HMS Students and Teachers please let me know if you need to speak with me for an counseling session or a counseling referral for a student by completing this form. I will arrange a time and date with you before you visit.
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* Indicates required question
What is the student's grade level?
*
Sixth (6th)
Seventh (7th)
Eighth (8th)
Student 's First Name
*
Your answer
Student's Last Name
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Your answer
TEACHER'S ONLY- Referring Teacher's Name
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Your answer
How are you feeling? (student's response only)
Happy, Elated, Joyful....
Sad, Somber, Gloomy...
Confused, Puzzled, Baffled...
Angry, Furious, Outraged
Scared, Shaken, Anxious...
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What periods do you take PE and elective classes(Art, Band, Music, or Technology)?
Your answer
Briefly tell me about the problem that you are experiencing.
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Your answer
What is the level of your problem?
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Low (Schedule me when available)
High (Schedule me as soon as possible)
Emergency (See me now)
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