Request to See the Counselor

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To be used in non-emergency situations. If there is a safety concern for you or another studnet, please find a counselor or admin immediately.

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First Name *

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Grade

My problem is

Check as many as apply

I'm worried about something at home.

I'm having problems with grades.

I have questions about my credits

I have questions about my schedule

Grief

I'm feeling nervous and/or anxious.

I'm feeling sad.

I'm feeling angry!

Another problem not on the list.

Other:

I need to see you

Sometime in the next 24 hours

Sometime this week

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My counselor is

Mrs. Denton (A-G)

Mrs. Baronich (H-O)

Mrs. Sherwood (P-Z)

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