School Counselor/Administrator Request

This is for students who would like to make a REQUEST to see a counselor or an administrator about a topic that is NOT an emergency. The counselor or administrator will contact you or send for you to come to their office when they are available. If you need to see a counselor or administrator about an issue that involves you or someone that you know being in danger, please find or make contact with an adult immediately.

Name Name First Last
Student Number
Must be 6 characters. Currently Entered: 0 characters.
Current Grade Level

Current Grade Level 9th 10th 11th 12th
I would like to meet with:
Reason to see a Counselor or Administrator:

Reason to see a Counselor or Administrator: Personal Credit Recovery/APEX Conflict with another person Online class question/Online class approval (Counselor only) Academic Question/Concern Planning for next year (Counselor only) Dual Enrollment (Counselor only) Other: Brief Description Other: Brief Description
Additional Information (if necessary)
Student (or parent) Email Address
(NOTE: please check for reply messages in both inbox and spam/clutter folder)
Student (or parent) phone number Student (or parent) phone number - ### - ### ####
Which do you prefer (check as many as apply):

Which do you prefer (check as many as apply): Contact by email Contact by phone/text Conversation in person
(Counselor/Administrator Only) Met with Student

(Counselor/Administrator Only) Met with Student Yes No
Date met with student Date met with student / MM / DD YYYY
Summary Conference