23-24 Roosevelt Counselor Contact Request

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Email *

First name *

Last Name *

Grade *

Grade 6

Grade 7

Grade 8

How would you like your School Counselor to contact you? *

Phone Number

Zoom Meeting

Please provide your phone number so that we can contact you. Please note: Our phone number may show as blocked. *

What topic(s) would you like to talk about? *

Academic: Grades, Assignments, Classes etc.

Social-Emotional: Feelings, concerns, need to talk and check in with someone

College/Career

Other:

I understand that my School Counselor may not receive this request immediately. If this is a crisis, please contact emergency services at 911. I also understand that anything I talk with my School Counselor about is confidential, unless I disclose that I am hurting myself, someone else, or that someone is hurting me. *

I agree, and understand

Required

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