Fischer Counseling and Resource Request

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Hello Fischer Families! If you are interested in any counseling services for your student and/or resources for your family, please fill out this form.
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Requests made after-school, in the evening or on the weekends will not be checked until the next school day.
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DO NOT USE THIS FORM IF YOU OR SOMEONE IS HAVING A PHYSICAL OR MEDICAL EMERGENCY.

Note that you will be contacted by the school counselor, Ms. Abad to confirm your needs.

*Please fill out one form for each of your students.
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Please use one of the following crisis resources if you need immediate assistance

- Call 911 or go to the nearest hospital emergency room safely

- Crisis Text Line: text "LISTEN" to 741-741

-(24/7)National Suicide Prevention Hotline
-For English : 1-800-273-8255
-For Spanish: 1-888-628-9454

-(24/7) Santa Clara County Suicide and Crisis hotline
- 1-855-278-4204

-(24/7) Bill Wilson Center
-408-850-6125

(24/7) Alum Rock Counseling Center Mobile Crisis
- (408) 294-0579

(24/7) Uplift Family Services Mobile Crisis:
-(408) 379-9085

Please choose an option *

I am the parent/guardian requesting services/resources for just my student.

I am the parent/guardian requesting services/resources for myself and/or my family.

I am the parent/guardian requesting services/resources for my student and family.

Your Name: *

Student's Full Name *

Grade level *

6th

7th

8th

Services that you are interested in (check all that apply) *

Individual Counseling/Therapy Services

Check-in with the Fischer school counselor

Family Therapy

Grief/Loss Support Services

Behavior Support

Parenting Support

Community Resource Linkage for Basic Needs (ex: food, shelter, clothing, financial assistance etc)

Mentoring

Academic Support Resources

Other:

Required

If you chose "Other" above, please explain:

Please provide us with the best phone number we can reach you at. *

When is the best time to reach you? *

Is there anything else you'd like for us to know or ask?

Submit

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