2022-2023 Parent Request for Counseling
Ms. Ridgeway and Ms. Arguello welcome PJH parents to fill out this form any time there is a need for a student or family to see us.  Just let us know what's going on and we will follow up as soon as possible.  Everything you enter here is kept confidential!
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Student Name (First and Last) *
Parent Name (First and Last) *
Parent Email Address: *
Child's Counselor *
Academic Reason for Referral:
Check all that apply
Social / Emotional Reason for Referral
Check all that apply
Brief Description of your concern or anything you think would be helfpul *
We/ my child would like to see you: *
We will try and see you child as soon as we can.  Sometimes we have other appointments or meetings and cannot reschedule.  Thank you for your understanding.
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If you would like to attend the meeting with your child, what time of day is best:
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