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Student Request to see Counselor
Please complete this form and Mrs. Cox or Ms. Melton will call for you when they are available. If this is an emergency, please come to the office and ask to speak to Mrs. Cox or Ms. Melton.
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Date
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MM
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DD
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YYYY
Your Name (First and Last)
*
Your answer
Grade
*
6
7
8
Please give your reason for wanting to see the counselor. Please be as specific as possible.
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Your answer
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