Roosevelt Counselor Contact Request

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Hi Students, as we continue with phase 2 learning (in person and online) we want to make sure you still have access to talk with your counselor. Please use this Google form to connect with us for any reason. We are here for you, and we will get through this together!

With Roosevelt PRIDE,
The School Counselors

Email *

First name *

Last Name *

Grade *

Grade 6

Grade 7

Grade 8

How would you like your School Counselor to contact you? *

Phone Number

Zoom Meeting

Please provide your phone number so that we can contact you. Please note: Our phone number may show as blocked. *

What topic(s) would you like to talk about? *

Academic: Grades, Assignments, Classes etc.

Social-Emotional: Feelings, concerns, need to talk and check in with someone

College/Career

Other:

I understand that my School Counselor may not receive this request immediately. If this is a crisis, please contact emergency services at 911. I also understand that anything I talk with my School Counselor about is confidential, unless I disclose that I am hurting myself, someone else, or that someone is hurting me. *

I agree, and understand

Required

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