Counseling Center Contact Information

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Please complete this form to schedule a time to meet with your School Counselor or Intervention Specialist.

During School Hours: If you or someone you know is having thoughts of suicide or thoughts to hurt others, please report to the counseling center immediately or tell a trusted adult.

After School Hours: If you or someone you know is having thoughts of suicide or thoughts to hurt others, please tell a trusted adult, call or text the Suicide Prevention Lifeline at 988, or in case of emergency, contact 911.

Email *

Record my email address with my response

First Name: *

Last Name: *

Grade Level: *

9th

10th

11th

12th

Reason for Counselor Visit: *

A+ Program Question

Academic Questions/Concerns

ATS Questions/Concerns

Attendance Questions/Concerns

Career/College/Course Planning

Scholarship Assistance

Self-Harm

Social/Emotional Issues

Suicidal Thoughts

Other:

Required

Timeframe for Counselor Visit: *

As soon as possible (I understand my counselor may be out of the building or unavailable; therefore, I will report to the main office or counseling center for urgent matters).

At counselor's earliest convenience.

Comments for Counselor:

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