Parent Student Request Form

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Hello Parents!

To refer your Maverick for a counselor meeting or check in please fill out this form. Once this form has been submitted, students will be picked up based on availability. I will also reach out to collaborate based on the information given.

If you or your Maverick have an urgent matter, please call (470) 615-7663 or send an email erin.mckelvey@libertytechcharter.org instead.

Thank you!!

Email *

Student First and Last Name *

What grade is your student in? *

It is an Academic concern

study skills

attendance

organization

homework

underachievement

Other:

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It is a Social/Emotional concern

social skills/friendship

confidnece/self-esteem

emotion regulation

conflict with peers/friends

coping skills

family related

grief/loss

personal hygiene

anxiety

Other:

Clear selection

There is another matter at hand,

Please provide me with information on your concern and how I can best assist your Maverick.

Additional information for Academic and/or Social & Emotional concerns

Submit

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