Elementary School Counseling Support Parent Request Form 23-24
Please fill out this form if you have concerns about your student(s), would like the School Counselor to check in with them/involve them in a small group OR if you need help connecting your child with a community Mental Health Therapist.
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Email *
Date
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Your Name: *
Your phone number: *
Your Student's Name: *
Your Student's Grade Level: *
Your student's teacher: *
How has your student been doing this summer and over the last few weeks as we have approached a new school year? Have they seemed happy, angry, sad, frustrated, angry, anxious (etc.)? Have you noticed any changes in their behavior, attitude, feelings? *
Has your child expressed any feelings or concerns about the beginning of the year? (Worry, stress, fear, nervous, sad, excited, happy...etc.) *
Are you concerned about your child’s Mental Health? *
Small Group Opportunities:
At some point during the school year, we will be offering small groups on the following topics. Please check the topics you may be interested in for your child. Groups will range from 20-30 minutes and will meet once a week for 6-8 weeks.
Please select groups you may be interested in for your child (starting date for these groups will be decided at a later time based on need and requests):
Are you interested in connecting with a Community Mental Health Therapist? *
Is there anything I can help you with? Please let me know how I can help.
Gracie Billings - Elementary School Counselor- 715-866-8210 ext. 125 - gbillings@webster.k12.wi.us
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