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Student Request to see the Counselor/Solicitud Para ver la Consejera
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* Indicates required question
Today Is..
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MM
/
DD
/
YYYY
Mrs. Durán (Grades: Kindergarten, 2nd, & 4th)
Mrs. Malena (Grades 1st, 3rd & 5th)
Please write your complete name (First, Last). Escriba tu nombre completo (Primer y apellido)
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Your answer
Student ID Number (lunch number) Numero de tu ID.
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Your answer
Grade / Grado
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Kinder
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Required
Teacher Name/Nombre de Maestra(o)
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Your answer
How are you feeling? / ¿Cómo te sientes?
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Happy / Feliz
Sad / Triste
Confused / Confundido
Stressed / Estresado
Angry / Enojado or Agitado
Anxious or Nervous / Ansioso o Nervioso
Other / Otro
Required
I need to speak to the counselor about.../ Necesito hablar con la consejera sobre...
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My Schoolwork/Mi Trabajo de escuela
My friends/Mis amistades
My feelings/Mis sentimientos
My family/Mi familia
Something secret/Un secreto
Something else/Otra cosa
Required
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