School Counselor Access Form for Margaret Whiting

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please use this form to reach out if you or your student would like to connect with me. I am here during school hours 8:00am - 4:00pm Monday through Friday. See below if you are in crisis and need immediate help.

Email *

Student name: *

Today's Date *

YYYY

Parent Name (if referring student)

Are you a parent or student: *

Parent

Student

Teacher

Other:

What is the best way to contact you? Please include your email or telephone number. *

These might be some reasons that you would reach out to a school counselor. Please check all that apply: *

Covid-19 Anxiety

Graduation/High School Class Concerns

Depression/Generalized Anxiety

Resource Needs

Parenting support and resources

Other:

Required

Please list other

Very Important:

If you or your student are having thoughts of suicide, please call 911 and/or contact Tillamook Family Counseling Crisis Center immediately. They may be reached at (503) 842-8201.

Please remember that your school counselor may not be available at the time you submit the form. School counselors are happy to teach skills, provide resources, and counsel during a crisis. For ongoing and more therapeutic needs, please contact one of the following resources that can assist you:

Tillamook Family Counseling Center
(503)842-8201

Adventist Health Tillamook
(503) 842-4444

Tillamook General Hospital
(503) 842-4444

Tillamook Community Health Centers
503-842-3900

Tides of Change
(503) 842-9486

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Neah-Kah-Nie SD. Report Abuse

Forms