Counselor Request Form-English
Parents may complete the form on the behalf of the student. I would like to talk with Ms. Spikes
If this is an EMERGENCY please immediately see to your teacher, a parent, or trusted adult.

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I would like to talk to you...
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My first and last name
My Student ID Number (if you know it)
My grade
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My Homeroom Teacher
I would like to speak to Ms. Spikes about....(check any/ all that apply)
Is there anything else you would like me to know before I schedule our meeting?
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I will be checking these requests daily. Please fill out the form as completely as you can, and I will contact your teacher to set up a time to meet!                Please understand that confidentiality cannot be guaranteed in virtual meetings. Ms. Spikes will make every effort to ensure a confidential conversation, and as always if she is concerned you may harm yourself or others, or that someone is causing you significant harm, she will notify the appropriate persons.
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