Graden Parent Referral Form
Hello Graden Parents/Guardians!

You may use this form to request that your child visit with the school counselor. This form can be used to refer any Graden Student, online or in-person. You are also welcome to send me an email at gittemeierc@parkhill.k12.mo.us or give me a call at 816-359-5647, shoud you want to discuss the situation more in depth.

Please note: If this is an emergency and someone is in danger, please call the school directly.
Email *
Name of Person Making the Referral *
Telephone Number *
Preferred method of contact: *
Name of child(ren) you are referring to see the counselor: *
Grade Level(s) of child(ren) you are referring (check all that apply): *
Required
Reason for Referral *
Briefly describe the issue/why you would like your child to speak to the school counselor: *
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