Mercy Junior College

9209 Tubod, Lanao del Norte

Philippines
Guidance and Counseling Office

COUNSELING STUDENT FORM

Dear Student,
Please fill-up this form if you feel and need someone to share with. Kindly send this form
directly to my email address: sr_jean-d@yahoo.com / MJC Guidance and Counselling FB page
in messenger. I will attend to you as soon as possible. Thank you so much.

Sr. Jean D. Delgado, RSM, RGC

School Guidance Counselor

STUDENT’S NAME: ____________________________________________________________________

TEACHER’S NAME: __________________________________________________________________
GRADE: _________________________
DATE: ___________________________
Contact Number: __________________

I would like to talk with you about:

__________My family
__________Myself
__________My feelings
__________My school work
__________My class
__________My friends
__________Something secret or private

This:
_____is an emergency
_____very important
_____can wait