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Social/Emotional/Family Information for Counseling Department
This form is to be completed only if there is any significant information regarding your student’s needs that we should know. If needed, submit the form separately for more than one child.

This form will be kept in the Counseling Department and is meant to assist the school counselors in addressing any additional needs your student may have.  

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Student's Last Name *
Student's First Name *
In the 2022-2023 school year, the student will be a: *
Please mark the appropriate situation(s) of which we should be aware: *
You may check more than one box.
Required
Please describe your son's additional needs/accommodations in greater detail. *
If relevant to your son’s needs, has appropriate documentation been sent to MUHS?
Leave blank if no documentation is relevant.
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If your son is taking any medications, would you like to share that information?  
Please note that you do not need to share any medication information unless you are comfortable doing so.
Please forward this information to:
You may check more than one or leave blank if you want this to simply stay on file with the Counseling Department.
TO ALLOW TIME FOR PROCESSING, PLEASE SUBMIT THIS FORM NO LATER THAN FRIDAY, SEPTEMBER 2, 2022.
If you have an issue or information you need to discuss with Mrs. Reuchlen, director of counseling, please email reuchlen@muhs.edu or call 414-933-7220, ext. 3070.
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