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Request to see the Counselor

Use this form to see the counselor. A student can complete the form as well as a parent/guardian, teacher, principal, or classmate who has a concern for a student. The counselor will prioritize and visit with students as schedules allow. If there is an emergency or a student is in danger during school hours, pelase go to the office or call 361-664-9822 to report it to the principal or counselor. 

Student Grade*
Answer required for "Student Grade"
Who is making the referral for this student to see the counselor?
Answer required for "Who is making the referral for this student to see the counselor?"
Reason for the referral: How can the counselor help? (Check all that apply)*
Answer required for "Reason for the referral: How can the counselor help? (Check all that apply)"