BHS REQUEST TO SEE A COUNSELOR

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First Name: *

Last Name: *

ID Number: *

Email Address (some questions may be answered via email): *

Phone number where you can be reached: *

SELECT YOUR ASSIGNED COUNSELOR BY YOUR LAST NAME

Choose one: *

Corine Van (Last Names A - CON

Pamela Perrone (Last Names COO - GOM)

Nikki Surley (Last Names GON - JOH)

Shakaria Maxey (Last Names JON - MIT)

Melissa Martinez (Last Names MIX - RID)

TaShauna Green (Last Names RIO - T)

Justin Estes (Last Names U - Z and 11th/12th grade IB Diploma Students)

REASON FOR REQUESTING TO SEE YOUR COUNSELOR

Please use complete sentences and be very specific. What can your counselor help you with? *

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