Request to Meet With a Member of Student Services

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Please fill out the form below and a member of the student services team will be in contact with you shortly.

You MUST fill out this form to meet with a member of the student services. After filling out the form, you must remain in class until a counselor calls for you.

Email *

Last Name *

First Name *

I am a... *

Student

Parent

Other:

How would you like to have this meeting? *

Virtual (Google Hangout)

Phone call

Other:

Please leave your email or phone number that you can be reached at for your meeting. *

Who are you trying to see? *

Ms. Lipscomb (A-F) School Counselor

Mrs. Whitman (G-O) School Counselor

Ms. Adkins (P-Z) School Counselor

Ms. Woody (Special Programs Coordinator)

Mrs. Whitt (Social Worker)

Mr. Ceballos (College Advisor)

Ms. Oakley (PCC Liason)

I have questions or concerns about... *

College and/or Career

Grades

Friends and/or Classmates

Personal Issues

PCC Classes

Attendance

Other:

Best time to schedule a meeting.... Please list multiple days and times that work best (Please note that this is a request only. Students will not be called out of EOC courses or courses the student is struggling in.)

What other information would you like me to know before our meeting?

Submit

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