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Chico Unified School District Citrus Elementary

1350 Citrus Avenue, Chico, CA 95926Driving Directions (530) 891-3107

Counseling and Wellness Office - Elementary School

Is this an Emergency? *Required

Yes No

If you, or someone you know, is currently experiencing a mental crisis or an emergency call 911.

The National Suicide Prevention Lifeline provides 24/7, free and confidential support for people in distress: 1-800-273-8255.

What is your role? *Required

Student Adult

Why do you want to meet with a couselor? (Check all that apply) *Required

I feel sad, hurt, upset or mad. I just need to talk to someone.

What is your name? *Required

What is your student ID? (If you don't know, write, "Not sure" or "?") *Required

Who is your teacher? *Required

What is your relationship to the child? *Required

Parent/Guardian Family Member Other Trusted Adult (e.g. caseworker, child advocate, etc.)

Why do you want to meet with a couselor? (Check all that apply) *Required

I need to speak with a school counselor regarding my child who attends the school. Our family is having a difficult time and we are struggling. There are family events that impact my child and I would like to let a counselor know.

What is your name? *Required

What is your child's name? *Required

What is the best way to contact you? (Please list email address/phone number) *Required

Please provide a brief description regarding what you would like to discuss. *Required 0 of 500 characters

Which days work best for you or the best time to reach you? (Check all that apply) *Required

As soon as possible Monday Tuesday Wednesday Thursday Friday

What is the best time to reach you? *Required

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Knowingly reporting a false threat is a crime.

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