School Counselor Referral
Please complete this for to request school counseling support for yourself or a student at our school.

Hello! Thank you for taking the time to complete this referral form. If this is an emergency, life threatening, or someone is in need of immediate attention please do not indicate below. Please call 911 or alert the school immediately.

This is not a referral to a live support provider and responses may not be reviewed daily or during school breaks.

If you or someone you know is in crisis outside of school hours please dial 988 or 211 or text "Home" to 741741 for immediate response.


Sign in to Google to save your progress. Learn more
Email *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Brea Olinda Unified School District. Report Abuse