School Counselor Request Form

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Parents/Guardians: Thank you for reaching out to your school counselor! You can request a meeting for yourself or your student.

As a school counselor, I can address academic, behavioral, social and emotional needs. Services include short-term individual counseling, crisis intervention, group counseling, restorative practices, and outside referrals as needed.

Email *

What is your first and last name? *

Email address or phone number (whichever form of communication you'd like me to use) *

Are you requesting a meeting for you or your student? *

I would like to meet with you

I would like you to meet with my student

Please give a brief explanation why you would like me to meet with you or your student. *

Submit

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