Request to see Care Team (Counselors or Social Worker)

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Request to see Care Team (Counselors or Social Worker)

Please complete this survey if you would like to be contacted by someone from the Care Team.

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* Indicates required question

Email *

Your email

Last Name *

Your answer

First Name *

Your answer

Grade level *

6th

7th

8th

Not applicable

I need help with: *

Academics

Emotional Stress

Schedule

Other:

Are you a teacher, student, or parent? *

Teacher

Parent

Student

I would like to talk to: *

Ms. Pastusek

Ms. Rodriguez

Ms. Hayes

No preference

Phone Number (Parent, Teacher only)

Your answer

How important is your need to speak to me? *

Important but it can wait

1

2

3

4

5

Very important and immediate

Submit

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