student-contact

Walker Upper Elementary School - 1564 Dairy Rd., Charlottesville, VA 22903 - (434) 245-2412

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Peace Squad

Use this form to sign-up to see your counselor.

Name *

First

Last

Grade Level *

5th Grade 6th Grade

Choose Any *

This is a problem at home This is a problem at school This is a problem with adults This is a problem with kids This is about drama with friends I just want to hang out for fun

On a scale of 1-5, how severe/important is this issue: *

5 - Someone might get hurt! 4 - I'm so upset I can't think 3 - It seems like a lot of things are going wrong 2 - I'm just having a bum day 1 - Nothing's wrong, I just want to visit! 0 - I want to have lunch with you and a friend

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