Sheffield High School Counseling Referral
Please complete referral to share concern about your child or student. Please allow 24-48 hours for follow-up to occur. Thank You,

Important Note: If there is a crisis, please contact the District's Social-Emotional Support Line or website for specific support.

Shelby County School District SEL 24-HOUR INFORMATIONAL & Support LINE

Live Support Line                           Information Line
Phone: 901.416.8484                      Phone: 901.416.2266
Hours: 9:00am-4:00pm                  Hours: 24/7                     
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*Required

1. Today's Date
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2. Student's First Name*
3. Student's Last Name* *
4. Students Grade Level *
Clear selection
5. School Counselor's Name*
Clear selection
6. Area of Concern (select a minimum of two (2) if there are several concerns) *
7.  If "Personal or Unknown," is selected in previous question, please describe concern below. *
8. Current Service(s) Received (select appropriate response below) *
9. If "Other" was selected in previous question, please describe additional service below: *
10. Person or Staff Submitting Referral *
11. If "Other" was selected in previous question, please describe role below:*
12. Contact Information: Name, Phone Number, E-mail*
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