Vintage High School Peer Support Referral (2023-2024)
We are Vintage High School students that are here for you.  We provide a place for safe conversations, support and connection for times when you just need someone to listen and understand what you are going through.

Do you have anything going on in your life stressing you out?  Causing you problems?  School?  Family?  Friends?  We are students trained to be Peer Mentors.  We simply provide one on one listening; we're not trying to solve your problems, tell you what to do, or get you in trouble.  In fact, everything you share is confidential meaning it stays between you and your peer mentor.  

Fill out the referral form and we will be in contact as soon as possible.  

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Email *
Student Perm ID Number 
Student's Last Name *
Student's First Name *
Their grade: *
Today's Date *
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Does the students need a mentor that speaks Spanish? *
Referred by (Your Name): *
My concern is regarding:
Please explain your concern for the student.  
Does this student know they are being referred? *
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