JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Counselor Contact
Request an appointment with Ms. El (6th grade and 8th Grade L-Z) OR Mrs. Burdett (7th and 8th grade A-K)
*Required
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
What is your Name? (Parents, please list your student's full name and then your name)*
*
Your answer
What is your Grade Level?*
*
Your answer
Choose a Counselor (We are a team and work together)*
*
Ms. El (6th grade and 8th Grade L-Z)
Mrs. Burdett (7th and 8th grade A-K)
First, is this an emergency? Counseling Emergencies may consist of: thoughts of self-harm or suicide, harming others, abuse, unsafe at home, concern for a friend's safety, and others. Listed above are just some school "emergencies".*
*
yes
no
maybe
Please give us a quick description of how we may help you.*
*
Your answer
Please let us know which period would be best to meet with you. We like to meet with students outside of their core classes (reading, math, LA, science, SS). If it is an emergency, type "Emergency"*
*
Your answer
Is there anything else you think we should know?*
*
Your answer
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Douglas County School System.
Report Abuse
Forms