Request to See Counselor

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Please provide your counselor with more information on what you need help with so she can prepare to help you.

If this is an EMERGENCY and you do not have immediate access to a counselor, please speak to a trusted adult ASAP, call 911, or call the Suicide Prevention Lifeline: 1.800.273.8255.

Student First & Last Name *

Grade *

9th

10th

11th

12th

How urgent is this matter? *

A big deal: I'm dealing with an emergency-risk to self, others, someone is hurting me or I know of a threat

Important: Some examples include but are not limited to grief, depression, anxiety

Not urgent: Some examples include but are not limited to stress, family concerns, peer relationships

I just wanted to say hi.

Reason for Request - I need help with: *

4-Year Graduation Plan

College Applications

COVID-19 Related Issue

Family Issue

Friendship Issue

Just Need to Talk

My Mental Health

My Grades

My Schedule

Personal Issue

Worried About a Friend

Other:

Quick Summary of Questions or Concerns *

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