Note to MY Counselor

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Hello!!! Ms. Butler, here. Need to see me or another student does? Complete this quick note for me.

YOU ARE IMPORTANT and so is each person in our school (so I will see you as soon as I can). If need immediate support and I'm not available, let another TRUSTED ADULT know.

If you cannot reach someone face to face during an EMERGENCY, please call Georgia Crisis & Access Line (GCAL) 1-800-715-4225

Email *

First Name *

Last Name *

Situation *

Please select all that apply

Academic

Emotional (feelings)

Social (family/friends)

Other (explain below)

Other:

If you clicked "other", please explain here: *

Level of Urgency (please, BE HONEST) *

Emergency

Need To Chat

Preferred Method of Communication? *

Face-to-Face

Video Chat via School Approved platform (Zoom, Google Meet)

Speak to Counselor via Email

Current Location

A copy of your responses will be emailed to the address you provided.

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