PWMS Counselor Request Form 2023-2024

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete this form to request a meeting or give information to the counselors. Students, parents/guardians, and staff members can complete this form and a counselor will address the request as soon as possible.

This form and responses are only monitored during school hours. Any responses provided outside of school hours will be reviewed and addressed on the next school day.

If this is an emergency outside of school hours, please call 911 or other authorities for help.

Email *

What grade level is the concern? *

6th Grade (Ms. Schmidt)

7th Grade (Mr. Streeter)

8th Grade (Ms. Thomas)

Please choose from the options below: *

I am a student

I am a parent/guardian

I am a PWMS staff member

Other:

Student First Name *

Student Last Name *

What general issue/concern do you have? *

I have a conflict with another student and need help to resolve it.

I would like to report a concern I have about another student.

I need someone to talk to about a personal situation.

I am having trouble with my classes and need some help.

I need resources (clothes, food, school supplies, etc.).

I would like assistance with college/career options or selecting courses.

I am a parent/guardian and would like you to meet with my student.

I am a parent/guardian and would like you to contact me regarding a concern.

I am a staff member and would like you to meet with a student.

Other:

Required

Would you consider this issue/concern an emergency? *

Yes

I don't know

Brief Description of Issue/Concern *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Union County Public Schools. Report Abuse

Forms