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Counselor Help Request 2019-2020 Grades K and 3rd
Please fill out if you would like the counselor to help you with something. For counselor emergencies, please call the front office.
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* Indicates required question
Teacher's Name? (First and Last Name)
*
Your answer
Name(s) of student(s) that this request is regarding? (If applicable)
Your answer
On a scale from 1-5, what is the priority of this request?
*
Select answer that best describes your needs.
It can wait
1
2
3
4
5
Extremely Urgent
What type of request is it?
*
Counselor meeting with student(s)
Counselor meeting with teacher(s)
Care team
Contact a parent
Teach or discuss a certain topic to your class
Speech concern
Student attendance or tardy concern
Other:
Please explain any important details to your request that you would like the counselor to know.
Your answer
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