Refer your child to the School Counselor

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Hello! Please complete the form below if you would like for me to check in with your child. If we are in virtual learning, I may need your help to meet with your child on Zoom. You can also call me at 573-214-3640, text me at 573-340-5341, or email me at lwright@cpsk12.org.

STUDENT first AND last name *

YOUR first AND last name *

Your relationship to the student (please note that I can only discuss a student with you if you have guardianship of that student and it is documented with the school) *

Parent

Guardian

Other:

How can I help your child? *

My child is feeling anxious or stressed

My child is overwhelmed with schoolwork on Zoom

My child is struggling with family or home changes (sick family member, separation, divorce, family member moving in or out, etc.)

My child is grieving a death

My child is struggling with following rules on Zoom meetings

My child is feeling angry and/or having difficult behaviors at home

My child is feeling very sad, lonely, or depressed

My child is doing okay, but I would like for him/her to meet the school counselor on Zoom to build a relationship

My child struggles making and keeping friends

Other:

Required

Which would be better for your child? *

Meeting individually with the school counselor

Meeting in a small group with other students that have similar feelings

I'm not sure

Either one would be helpful

How do you prefer that I contact you? *

Phone call

Text

Other:

Please share the best phone number or email address to reach you. *

Is there anything you would like to share about your child before I check in with him/her?

Submit

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