Counselor Referral
Welcome to our online virtual counseling request form. This form is a communication tool for staff, parents, and students to address any needs that may occur during our physical absence of school. Please fill out the form in its entirety and then schedule an appointment so that I can get in contact with you as soon as possible.Once the form is submitted, I will then send you a confirmation email with your appointment time and the tool we will utilize to communicate. We will utilize "TEAMS" for videoconferencing or by phone. Your preference.
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Email *
Please indicate your preferred method of communication
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Phone Number
Please indicate if you are a parent, student, or teacher
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Student Name (1 Form per child only)
Homeroom Teacher
Parent Name
Please share what you would like to discuss.
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If you chose "Other" please type your concern.
How important is your  need to speak to me?
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Submit
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