Counsellor Request Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Complete this request sheet to inform the Wrap Around (counsellors) that you would like to speak with them. If your reason is time sensitive, please tell a teacher, go to the office, come to the Wrap Around or see the Constable during a break. Otherwise, one of the counsellors will call you down to discuss your matter once they have received this form and have the opportunity.

Email *

Record my email address with my response

First and Last Name *

Grade *

I prefer to speak with (check all that apply): *

Mr Bellerose

Ms Deacon

Autumn

Whoever is available first

The reason for your visit is: *

PERSONAL (life issue you want to discuss)

ACADEMIC (grades, classes, homework, marks)

TIMETABLE (course change, scheduling)

CAREER (credit check, grad info, post-secondary, etc)

Other:

Anything else we need to know? *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Northern Gateway Public Schools. Report Abuse

Forms