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NHMS Student Request to See Counselor
Counselors are available Monday - Friday from 8:15 am - 3:30 pm (except holidays and breaks) 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.
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* Indicates required question
What is your name?
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Your answer
What is the student's full name
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Your answer
Does the student know about the referral?
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Choose
Yes
No
Student Self-Referral
Relationship to student if not a self referral
Your answer
Counselor
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Ms. Brennan (Last names A-K)
Ms. Quach (Last names L-Z)
Grade
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6th
7th
8th
What best describes your current needs?
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Talk to someone
Mindfulness activity/break
Academic support
Quiet place
Other
Additional information for counselor to know
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Your answer
How Urgent is the matter? 1- the student will be seen within a week 2- the student will be seen as soon as possible 3-the student will be seen immediately
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Level One- The student wishes to speak with someone, but it is not an emergency or you notice something is wrong with the student
Level Two- The student wishes to speak with someone and it is an emergency (but not one of the emergencies listed for level 3) or the student is visibly emotionally upset, but they can still remain in class
Level Three-They are so visibly emotionally upset that they cannot remain in class, they are a potential harm to self, harm to others, someone is harming them, or they know of a threat on campus.
If the student is in a crisis (threat to self or others, child abuse, disorientated or explosive), please contact the Main Office to arrange to have the student escorted to the office
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