Request a Partnership

1
Name of Person Completing this Form* This field is required.
First Name
Last Name
2
Title / Role* This field is required.
Please Select
Please Select
Superintendent
Principal
Director of Student Services
Director of Special Education
School Counselor
Social Worker
Psychologist
HR Administrator
Other
3
Email* This field is required.
example@example.com
4
Phone Number* This field is required.
Please enter a valid phone number.
5
School / District Name* This field is required.
6
How Can We Help You?* This field is required.
Please Select
Please Select
Interested in learning more about DG Counseling
Exploring mental health support options for students
Exploring crisis support resources
Interested in workshops or staff PD
Interested in parent education events
Interested in establishing referral pathways
Other
7
Preferred Meeting Format* This field is required.
Please Select
Please Select
Phone Call
Virtual Meeting (Zoom/Teams)
In-person (if available)
8
Meeting Availability (Provide at least 3 options)* This field is required.
Morning
Midday
Afternoon
Evening
Weekday
Weekend
Should be Empty: