AA Counseling Request Form

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Thank you for making a referral to the counseling department. Please keep in mind that it can take up to 2 school days for someone to get back in touch with you.

This form is to be used for general counseling referrals but not when there is an immediate safety need including threats to self or others.

If you or someone you know needs immediate assistance or is having an emergency situation please call 911 or the Suicide Prevention numbers: at 1-800-273-8255 or go the Trevor Lifeline (LGBTQ): 1.866.488.7386.

If you are looking for the contact information for one of our counselors or you prefer to book a time to meet you can either email us or make an appointment using our Calendly links. All of our contact information and Calendly links can be found on our website at: https://www.aa.edu/counseling-and-human-development/

Today's date: *

YYYY

Who is filling out this form? *

Parent/guardian

Student

Teacher

Other

What are you in need of? *

Counseling for a student

Resources

Parent conference (phone or virtual meeting)

Discuss concerns about your students

Other:

Student's name (first and last) *

Grade level of student being referred? *

What is the best way to schedule a time to talk or meet (please provide a phone number/ email address)? *

Any additional information you would like to share:

Submit

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