Student Request for Assistance Form

Hi Levi Dickey Student!

If you would like your counselor or someone else from school to contact you, please complete the following questions as best as possible.

--------Please remember that if you're having an emergency, call 911------

This form will be checked on a daily basis and you will receive a reponse as soon as possible. 

Your school counselor wants to also remind you that school counselors practice confidentiality. That means that everything you and the counselor discuss is private unless it's disclosed that a student is in danger of any kind by hurting himself/herself, by someone else hurting them in any way or if they share knowledge of someone else hurting others.

Note: Below are resources available should you find yourself or someone else in a situation where immediate mental health services are needed.

National Suicide Prevention Hotline --- 1.800.273.8255
Central Crisis & Suicide Prevention Hotline --- 1.888.506.5991
Crisis Text Line --- Text HOME to 741741

Click HERE to access the form.