Counselor Request Form - Castle Pines

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This form will notify a counselor at the Castle Pines campus of your request to meet. Please allow up to 1 week for a response.

If you have an urgent need (someone is hurt or may get hurt) please speak with a front office staff member (during school hours) to be put in immediate contact with a member of our mental health team, or use Safe2Tell or dial 911 outside school hours.

Your name (first and last): *

Are you a... *

Student

Parent

Staff member

Student name (if parent/guardian or staff member is completing the form):

Grade *

Kindergarten

1st grade

2nd grade

3rd grade

4th grade

5th grade

6th grade

7th grade

8th grade

I want to talk about *

Home/Something outside school

Schoolwork/Grades

Friends/Classmates

Feelings/Strong Emotions

Something else

Required

If you are having peer conflict, what have you tried already? Please try "3 before me" (try to solve the conflict using at least 3 strategies before asking a counselor for help).

Talk it Out (using I-Statements)

Take a Break (sometimes we need time apart)

Share/Take Turns/Compromise

Walk Away (remove yourself from the situation)

Apologize (if you've made a mistake, own it)

Other (write in below)

Other conflict resolution strategy:

Anything else you'd like us to know?

Submit

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