Request to see Mrs. K

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I am happy to set up a time to meet with you to support you. Please provide some basic information for me by answering the questions below. I will send a pass for you when the next available appointment opens up.

If this in an emergency which is a safety concern - DO NOT use this form!
Please tell your teacher right away so that they can make sure they help you contact the Counseling Department and we take care of your emergency quickly.

Thank you!
Mrs. K

Email *

Last Name *

Reason for requesting an appointment *

Personal (Home/Family Concern)

Academic (Need help with grades)

Schedule issue

I'm having a problem with my friend(s)

I would like to talk about an issue with my team/teacher

I would like to talk about myself and/or a friend being bullied

Concerns about self-harm(for myself or a friend) Please tell your teacher you need to see me right away.

Other:

Required

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