Request to see the Counselor

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Use this form to see the counselor. A student can complete the form as well as a parent/guardian, teacher, principal, or classmate who has concern for a student. The counselor will prioritize and visit with students as schedules allow. If there is an emergency or a student is in danger during school hours, please go to the office or call 903-989-2242 immediately to report it to the principal (ext. 2501) or counselor (ext. 2505)

Email *

Name of student to see the counselor: *

Student Grade *

Who is making the referral for this student to see the counselor? *

If not a self-referral, what is the referring person's name?

Reason for the referral: how can the counselor help? (check all that apply) *

Dual Credit

Testing (ACT/SAT/TSI/PSAT/STAAR EOC)

Difficulty with friends

Difficulty at home

Difficulty in class(es)

Personal issues

Self Harm

Other:

Required

Briefly describe exactly what you need help with. This allows the counselor to be prepared. *

Send me a copy of my responses.

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