Perry Counseling Department Appointment Request
Need to see your counselor?


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Email *
Last name: *
First name: *
Student ID *
Grade: *
Counselor/Social Worker/College & Career Specialist *
Counselors are assigned based on the last name of students. Please select your assigned counselor. All counselors are assigned grades 9-12.
Reason for my appointment request: *
We will respond to your appointment request via email. We will use the email you provided. *
You are requesting to be seen.... (please note:  most appointments will be scheduled for the next available day and time slot unless you have an urgent request) *
What times are you available?
Please select all that apply
Period 1
Period 2
Period 3
Period 4
Period 5
Period 6
Monday
Tuesday
Wednesday
Thursday
Friday
Will your parents be attending the meeting with you? *
Any other comments and/or questions?
A copy of your responses will be emailed to the address you provided.
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