Shelburne Help Form (for students and their parents/guardians)

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

This form is for school hours only (8:15am-3:40pm) and will not be checked after hours or on the weekends/holidays.
Emergency numbers:
National Suicide Prevention Lifeline : 988 or 1-800-273-8255
Child Abuse Hotline : 1-800-422-4453
911 for emergencies
Crisis Textline: Text HOME to 741741

Person to contact* *

First and Last Name *

Briefly describe your need* *

How would you like us to handle your need: *

I wish not to be contacted at this time, but please let the teacher(s) know this is happening.

I would like to be scheduled for an in-person meeting

I would like to be scheduled for a virtual meeting. (please be sure to check your email for a scheduled meeting)

I would like to talk over the phone (add your phone number below).

Other:

What days(s)/time(s) work best for the counselor to contact you?

Phone number for a phone meeting if needed

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Staunton City Schools. Report Abuse

Forms