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Counselor Request
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Grade
*
Choose
8
9
10
11
12
How urgent is your request?
*
Very urgent!
Pressing but not an emergency.
It can be handled when time allows. (No rush)
Briefly describe what's going on. Examples - Friend problems, home issues, class help, etc.
*
Your answer
Which hour is best to see you? (Check any that apply)
1st
2nd
3rd
Cavs Time
A Lunch
B Lunch
C Lunch
4th
5th
6th
7th
Before School
After School
Anytime will work
Do you have a specific SEL Support Person you'd like to see?
Mrs. Crawford
Mrs. Murphy
Mrs. Floria
Mrs. Gosaynie
Mrs. Steinecker
Mr. K
No Preference/ First Available
Clear selection
I understand that this form is
not
to be used in emergency situations. If you are having a mental health emergency see the nearest staff member or call 911.
I acknowledge that wait times to see a counselor may vary and be longer during busy times such as the beginning of semesters and during state mandated testing.
*
I acknowledge the above statements and my situation is not a life-threatening emergency.
Submit
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