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23/24 SCMS Office Appointment Request
Fill out this form to meet with your counselor. If this is an EMERGENCY please indicate that on the form, or come see a counselor immediately.
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* Indicates required question
Date
*
MM
/
DD
/
YYYY
Student Name
*
Your answer
Grade
*
Choose
6th
7th
8th
I need to speak with:
*
Choose
Mrs. Dunaway
Ms. Demyan
Mr. Mercer
I want to meet regarding the following (check all that apply)
*
Personal/Social
Grades Support/Questions
Schedule Questions
Report an issue/concern (ex: bullying, peer conflict, self harm, etc.)
Other:
Required
What steps have you taken to address this problem/concern?
*
Your answer
Priority of Request:
*
Choose
Normal
Urgent
This is a crisis/emergency
If there is a specific class period that works better for you to meet?
Your answer
Submit
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