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Student Self-Referral / Autorreferencia del estudiante
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* Indicates required question
Email
*
Your email
Student first name / Nombre del estudiante
*
Your answer
Student last name / Apellido del estudiante
*
Your answer
Grade Level / Nivel de grado
*
Your answer
Teacher's name / Nombre del profesor
*
Your answer
My problem is... / Mi problema es...
*
Worried about school / Preocupada por la escuela
Worried about home / Preocupado por el hogar
Having trouble with another student / Tener problemas con otra estudiante
Having trouble with an adult / Tener problemas con una adulta/adulto
Missing someone / Echar de menos a alguien
Can't concentrate / No puedo concentrarme
Having trouble managing my body and/or emotions / Tener problemas para controlar mi cuerpo o mis emociones.
I have a problem that is not on the list / Tengo un problema que no esta en la lista
Required
I need to see you / Necesito verte
*
RIGHT AWAY = BIG problem!! / INMEDIATO = GRAN problema !!
Sometime today / En algún momento hoy
Sometime this week / En algún momento de esta semana
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