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Odyssey Charter Student/Family Counseling Services Referral
Please fill out form entirely. We will return your request with a response to the email address provided.
*This is a form - not intended for emergencies.***
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* Indicates required question
Email
*
Your email
Last Name (of student)
*
Your answer
First Name (of student)
*
Your answer
Person submitting this form
*
Self
Parent/Guardian
Other:
Select Grade
*
Choose
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
Select Requested Counselor
*
Choose
Allie Rykaczewski- Lower School (K-2)
Courtney Papanicolas- Intermediate School (3-5)
Abby Robinson- Middle School (6-8)
Shannan Beck- High School (9-12)
Lori Jones- Family Crisis Therapist (K-12)
Student Concern - Check all that apply.
*
Personal Concern
Scholarship Information
College
SAT/PSAT
Naviance
Career
Academic/School Concern
Social/Emotional
Anxiety
Conflict Resolution
Grief/Death
Check in
Issue with Friends
Family Situation
Concern for a classmate
Other:
Required
Optional- Provide further details of your concern here
Your answer
Submit
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