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WC Friday - Counseling Referral Form
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* Indicates required question
Email
*
Your email
Student's first and last name
*
Your answer
Person making the referral
Teacher
Student
Parent
Clear selection
Reason for referral
Academic
Behavior
Personal
Peer Conflict
Other
Clear selection
Check here if situation is urgent
Urgent
Preference on in person VS. virtual meeting
In person if possible
Virtual meeting - if virtual please check your email for confirmation on a schedule meeting time
Clear selection
Use this space to provide more info on reason for referral (optional). If virtual is preferred, please leave suggestions on day/times for virtual meeting. Parents, please include contact number or email for follow up.
Your answer
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