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High School Student Request
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* Indicates required question
Email
*
Your email
Student Grade Level
*
Choose
9th
10th
11th
12th
Student Name (Last Name, First Name)
*
Your answer
Counselor
*
Mrs. Carrizales 9th grade (Last Names A-L)
Ms. Economides 9th grade (Last Names M-Z)
Mr. Schlabach 10-12th grades (Last Names A-L)
Mrs. Bushehri 10-12th grades (Last Names M-Z)
Reason for Referral
*
College/Future Planning
Friends
Family
Grief- Loss/Death
Bullying
Academic
Other:
Explain/Comments: (Anything that would be helpful for us to know ahead of time)
Your answer
How soon do you need to see your counselor?
*
Right Away! It is an emergency!!!
Sometime today
Sometime this week
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