School Counselor Request Form
The school counselor responds to student request forms as soon as she can. If this is an emergency (someone is/was/might be at risk of hurting self or being hurt by other/s) make sure to tell a teacher, parent, or other safe adult about your emergency.

The school counselor will approve the request when she can meet. Please do not come to Mrs. Keith's office unless there is an emergency or urgent need.
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My first name is: *
My last name is: *
Grade Level: *
I would like to talk with the counselor about *
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