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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.

Email Address*

Name of the student to see the counselor:*

If not a self-referral, what is the referring person's name?

Reason for the referral: How can the counselor help? (Check all that apply)*

Testing (ACT/SAT/TSI/PSAT/STAAR EOC)

Difficulty with friends

Difficulty at home

Difficulty in class(es)

Personal Issues

Self Harm

Other

Briefly describe exactly what you need help with. This allows the counselor to be prepared. *