NHS Counseling Form
2023-2024
Student Name
First Name
Last Name
Email
example@example.com
How can I help?
Be brief: “counseling,” “scholarships,” “career conversation,” “check-in,” etc
When are you available? (Lunch/study hall) CHOOSE MULTIPLE
Period 1 (8:15-8:56)
Period 2 (8:59-9:39)
Period 3 (9:42-10:22)
WIN (10:25-11:05)
Period 5 (11:08-11:48)
Period 6 (11:51-12:31)
Period 7 (12:34-1:14)
Period 8 (1:17-1:57)
Period 9 (2:00-2:40)
Advisory (2:43-3:05)
Urgency:
ASAP
Today if possible
This week
This month
Did you complete this form for yourself?
Yes
No
If you are referring a student, please type your name or title below.
Submit
Should be Empty: