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Mr. Krohn Counselor Request
This form is to request a time with the counselor. Please allow a week for a response. Communication will occur with your JAA apps email.
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* Indicates required question
Email
*
Your email
What is a good phone number you can be reached?
*
Your answer
Scholar's Last Name
*
Your answer
Scholar's First Name
*
Your answer
Grade Level
*
7th
8th
9th
10th
11th
12th
Elementary
Person Requesting
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Teacher Request
Administrator Request
Staff Request
Parent Request
Scholar Request
Counselor Request
Required
Reason for Request
*
Class Schedule Change
Credit Recovery
College
Academic
Study Skills
Organization
Peer Relationships
Bullying
Divorce
Stress
Anger
Grief
Anxiety
Sadness
Suicidal Ideation
Self-Harm
Coping Skills
Parent Meeting
Other:
Required
What are your concerns? Please be specific.
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Your answer
On a scale of 1-10 where are you today?
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Problem Free
1
2
3
4
5
6
7
8
9
10
Problem is at its worst
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