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Perry Counseling Department Appointment Request
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* Indicates required question
Email
*
Your email
Last name:
*
Your answer
First name:
*
Your answer
Student ID
*
Your answer
Grade:
*
9
10
11
12
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.
Mrs. Holli Cagle 9-12 A- COM
Mrs. Kimberly Leas 9-12 CON-HANC
Mr. Scott Uyeshiro 9-12 HAND-LOPER
Mrs. Kirstin Gregg 9-12 LOPES-PERE
Mr. Mark Nold 9-12 PERF-TAY
Mr. Fred Mann 9-12 TAZ-Z & All STEM Students
Ms. Skylar Gardner - Social Worker
Mrs. Kim Kwong - College and Career Center Specialist (Scholarships, College Representative Meetings, Tours)
Reason for my appointment request:
*
Your answer
We will respond to your appointment request via email. We will use the email you provided.
*
I understand I must check my email for my appointment time.
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)
*
Now, urgent request
Tomorrow
Sometime this week or next week
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
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?
*
Yes
No
Any other comments and/or questions?
Your answer
A copy of your responses will be emailed to the address you provided.
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