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Student Full Name*required

Do you feel your student could benefit from having one on one sessions with the school counselor? If so, how?*required

What are the best ways for your student to learn?*required

Does your student have trouble concentrating and staying focused?*required

How does your student express their feelings/emotions?*required

Do they struggle to manage their feelings/emotions?*required

How does your student cope with stress, aggression, frustration, and change?*required

Does your student ever express feeling sad, lonely, angry, hopeless, etc?*required

What future plans have your student discussed with you?*required

Has conversation about suicide been discussed with your student?*required

Has suicide ideation ever been an issue with your student or others in the home?*required

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