Request Counseling Services
Once you complete and submit this form an email will be sent to the SISD counselors and the student will be added to their lists of students to contact.

**If the presenting problem is dealing with some type of harm that qualifies as an emergency (the student is being harmed by someone, the student is planning to harm someone else, or the student is self-harming), please also contact local law enforcement and/or seek medical attention**
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Student First Name *
Student Last Name *
Grade Level *
Parent Name
Parent Phone Number
Person Requesting: *
Required
How quickly does this need to be addressed? *
Need to talk, but safety is not an issue.
Extreme fear for safety of student.
Please include a short explanation of the presenting problem. *
I prefer to be contacted by... *
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