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Student Counseling Request Form
Students, fill out this form if you want to talk to your school counselor.
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* Indicates required question
Email
*
Your email
FIRST and LAST name
*
Your answer
Grade
*
Kindergarten
1
2
3
4
5
6
How should we contact you?
*
Phone
Email/WebEx
See me on a day I am on campus
If you chose phone, what number should we call to talk to you?
Your answer
How are you feeling?
*
Option 1
Option 2
Option 3
Option 4
How soon do you need to talk?
*
It's a BIG deal. Please see me as soon as possible!
It's a little important. Please see me in the next few days!
It's not urgent. Please see me within the next week.
If you want to, briefly describe what's going on.
Your answer
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