Counselor Request 20-21

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This form must be completed prior to meeting with a school counselor. If this is an emergency, please come directly to the counseling office. An emergency is defined as you or someone else is at risk of harm. If this is not an emergency, requests will be addressed as soon as possible. A counselor or the counseling secretary will reach out to assist you. Please be patient as we may get multiple requests at one time.

Email *

Student First Name *

Student Last Name *

Grade *

I need to speak with *

Ms. Smith (Last Name A-K)

Ms. Stigall (Last Name L-Z)

Ms. Clark (Counseling Assistant-transcripts, KRS forms, Parchment help, etc)

Please choose the best description of your need. *

I need a transcript, driver's license form or other document request.

I need to report a bullying or harassment situation.

Today I am feeling overwhelmed and need a place to calm down or cool off.

I need to talk with my school counselor about future plans (College, career, ILP, etc.)

I would like to see my school counselor to talk about: attendance, study skills, goal setting, organization, underachievement, scheduling, etc.

I would like to talk to someone about a personal situation. No one is in danger.

I need to talk to someone because someone is or could be in danger.

I have a schedule issue.

Please give more information regarding issue below: *

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