Lava Ridge Counseling Student Sign-in

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

Please fill out the form below and we will do our best call you down as soon as we are able. Visit our website at counseling.lavaridge.net for more information.

Student First and Last Name *

Which grade are you in? *

6th

7th

What is your preferred contact information? (Phone number, email, etc?)

Who would you like to see? *

Mrs. Jesienouski (Mrs. J)-6th Grade Counselor.

Mr. Lounsbury-Decker (Mr. LD)-7th Grade Counselor.

Any Counselor

Are you feeling suicidal or are you reporting someone who is having suicidal thoughts or thoughts of harming themselves? *

Yes-for myself

Yes-for a friend

What do you need from the counselors? *

I need a class change.

I need a counselor for other reasons.

I was called down to see a counselor

Clear form

Never submit passwords through Google Forms.

This form was created inside of Washington County School District. Report Abuse

Forms