College & Career Specialist Request

This is for students who would like to make an appointment to see a counselor about a topic that is NOT an emergency. If you need to see a counselor about an issue that involves you or someone that you know being in danger, please find or make contact with an adult immediately.

Date Date / MM / DD YYYY
Name Name First Last
Grade Level

Grade Level 9 10 11 12
Student Number
Reason for Request

Reason for Request SAT/ ACT Waiver Scholarships College information Technical school information Other: Brief Description Other: Brief Description
Can your concern be addressed via email?

Can your concern be addressed via email? Yes No
Email
Met with Student

Met with Student Yes No
Date Date / MM / DD YYYY
Summary Conference