Springhill: Parent/Guardian School Counseling Referral (2023-2024)
This referral form is for parents and guardians of Springhill School students who would like for their child to meet with the school counselor, Ms. G. Ms. G will contact you after receiving this completed form to discuss your concerns and schedule counseling services for your child.      
                                        
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Your First and Last Name *
Student's First and Last Name *
What is your relationship to the student? *
Required
Grade Level *
Who is your student's teacher?
Reason for Referral. Check ALL that apply. *
Required
Please select if referral is for individual short-term counseling, for small group counseling, and/or parent consultation.  *
Required
Please provide a brief description of the reason for your referral. *
How would you like me to reach you? *
What is the best phone number and/or email to contact you? *
Priority *
Additional Comments
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