Kids' Notes

 

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Name:

Class:

Date:    

 

I would like to see the School Counselor for the following reasons:

 

___ FRIENDS--I often have trouble with my friendships.

 

___ SCHOOL--I often have trouble with my school work.

 

___ FEELINGS--I often don't feel good about myself.

 

___ FAMILY--I often have problems at home with my family.

       

___ DEATH/LOSS--I have experienced the death of a family member or friend.

 

___ OTHER--Here is the problem that I would like to discuss:

   

 

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