Counseling Appointment Request Form

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Please fill out the information below to request an appointment with your School Counselor during school hours (7:45am to 2:30pm). You will receive an email with a confirmed date and time within 24 hours. THIS FORM IS FOR STUDENTS ONLY. Appointments will be scheduled during asynchronous time and/or revision periods.

What is your name? (First and Last) *

What is your grade level? *

9th

10th

11th

12th

What is your email address? *

Who are your counselors? *

Mr. Stratton/Mrs. Hewitt (Team A - L / Last names A - L)

Mrs. Beecroft/ Mrs. Glowik (Team M - Z / Last names M - Z)

REMEMBER, if you're concerned about your safety, or the safety of someone else, it is important to contact an adult immediately. During school hours, please call 610-269-2420, ext. 81161 to reach a STEM staff member. If it is outside the hours of 7:30am-3:00pm, you should contact Valley Creek Crisis Center for immediate assistance at 610-280-3270 - OR call 911 if this is a life threatening emergency. *

I want to make a schedule change

I have a concern about a class or teacher

I have a personal/mental health concern about myself

I have a personal/mental health concern about another student

I want to discuss my organization and/or time management skills

I want to discuss college and/or career

Other:

Required

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