Hillcrest Counselor Conversation Sign-Up

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Any Hillcrest student, parent or staff is welcome to fill out this form. This form is confidential and will only be seen by school counselor, Halina Radosz. I will do my best to contact you within 24 - 48 hours of receiving your completed form (by Monday or Tuesday if you submit on a Friday).

NOTE: I am available during school hours 8:30am - 3:30pm, Mon-Fri only. If you or a family member is feeling unsafe or otherwise needs help right away, Crisis Services is available 24/7 at 413-774-5411 or call 911.

Email *

Student First and Last Name *

Name of Person Completing this Form *

Relationship to Student *

Parent/Caregiver

Teacher/Staff/Administration

Other:

Teacher and Grade *

Ms. Chanda - Pre K

Ms. Baron - Pre K

Ms. Sarah - Pre K

Ms. Drake - Kindergarten

Ms. Fox - Kindergarten

Ms. Lesenski - Kindergarten

Ms. Johnson - First grade

Ms. Smith - First grade

Ms. Thompson - First grade

Mr. Sinclair - Therapeutic

Ms. Tirrell - Special Education

Other:

How urgent is your concern? I will do my best to respond within the time frame indicated. (Please note that this form should only be used if your concern does not require an immediate response. For emergencies call Crisis at 413-774-5411 or call 911. If not a mental health crisis you may also call my phone at 413-863-7399 or email halina.radosz@gmrsd.org ) *

Please contact me today - I really need assistance today

Please contact me within 48 hours - I'm doing OK but this is important

Please contact me this week - I have some concerns but it is not urgent

What is the best way to reach you to set up a day/time? Please provide either a phone number or a personal email address. *

How would you like to have the counselor chat? *

By video chat (google meet)

By phone

By email

In-person meeting

Tell me a little about your or your child's needs (optional)

I or my student would just like a Check-in

Peer issue

Emotional concern (e.g. sadness, anger, anxiety/worry)

Behavioral concern

Help finding resources

Other:

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Is there anything else you would like to share about your or your child's needs?

Send me a copy of my responses.

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