Pelham City Middle School Counselor Request

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Pelham City Middle School Counselor Request

The purpose of this form is for students, parents and staff to request a time to talk with the counselor. Requests are kept confidential and once the counselor receives the request, contact will be made as soon as time is available.

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* Indicates required question

Who is making the request? *

Student

Parent

Staff

First and Last Name of Person Making Request *

Your answer

First and Last Name of Student Involved *

Your answer

Brief description of need/purpose of meeting with counselor: *

Your answer

On scale of 1-5: One being "no rush" and five being "very important", please rate your request to speak/see counselor. *

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