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Parent Request/ Referral to Meet with a THS Counselor
After completing the form below, please be patient. It may take 24 hours to be in contact with you.
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* Indicates required question
STUDENT Name ( First & Last)
*
Your answer
Grade Level
*
9th- Mrs. Mitchell
10th- Mrs. Mitchell
11th-Mrs. Foster
12th- Mrs. Foster
PARENT Name
*
Your answer
PARENT Email
*
Your answer
PARENT Phone
Please include area code
Your answer
Is this a request or referral ?
*
Request to meet with counselor
Referral for student to meet with counselor
How important is your request/referral?
*
Urgent (Needs immediate attention 1- 2 hours)
Important (It can wait 1-2 days)
Somewhat important ( It can wait awhile if necessary)
Reason for request/referral
*
Select all that apply.
Academic (Grades)
Personal/ Social (Family Concerns)
Career/College Planning
Attendance
Other:
Required
Short explanation of concern
*
Your answer
Best time to contact
*
Check all that apply.
8am-12pm
1pm- 5pm
After 5pm
Required
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