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LP Brown Elementary Counseling Referral
School Year 2023-2024
To Be Completed by Parent/Guardian
For questions, please contact:
Taryn Tessneer, MSW, LICSW
School Social Worker- Counseling
Direct Line: 360-596-6813
ttessneer@osd.wednet.edu
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Email
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Student Name
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Grade
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Kindergarten
1st
2nd
3rd
4th
5th
Teacher
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Ms. Russell
Ms. Christensen
Ms. Fulton
Mr. Boyer
Ms. Robbins
Ms. Dresow
Ms. Geiger
Ms. Bowden
Ms. Woodhouse
Ms. Whitehouse
Ms. Balderston
Ms. Ranney
Mr. Vanzant
Mr. Perez
Ms. Mickelson
Please select your preference for counseling support
*
Individual Grief Support (2-3 Sessions)
Individual Counseling - Family Changes (2-3 Sessions)
Individual Counseling - Worry/Anxiety (2-3 Sessions)
Individual Conflict Plan (2-3 Sessions)
Individual Anger Plan (2-3 Sessions)
Individual Friendship Plan (2-3 Sessions)
Individual Solution-Focused Counseling on a Specific Student-Centered Goal (6 Sessions)
Small Group- Choose Respect: Showing Respect to Peers and Adults
Small Group- Zones of Regulation: Managing Emotions and Practicing Self-Control
Small Group- Social Thinking: Staying with the Group, Empathy, Taking Others’ Perspectives, Flexible Thinking
Any - Counselor to Determine Service
Required
Additional Information:
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Parent/Guardian Phone Number
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By entering my name and submitting this form, I allow my child to meet with
Ms. Tessneer for the counseling support indicated.
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