Parent Permission for Counseling 23-24

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In a school setting, a school counselor does brief counseling which addresses problems within a few sessions. The school setting is different than a therapeutic/clinical setting where diagnosis and treatment plans are created and treatment is administered for a longer period of time.

The goal of school counseling is to address issues which impact learning while at school. If issues continue to impact the student's learning at school, after intervention by the school counselor, a referral to an outside resource will be suggested to the parent/guardian.

Email *

Student's Name

Homeroom Teacher

Parent/Guardian Name *

Social Reason for Referral

Social Skills

Anger Management

Negative Attitude

Anxiety

Confidence/Self-esteem

Grief/Loss

Peer Conflict

Family Conflict

Other

Academic Reason for Referral

Attendance

Attention in class

Organizaton

Study Skills

Homework

Under Achievement

Other:

This student would benefit from

One time visit

Several visits one on one

Small Group

Other:

Clear selection

Comments: Anything helpful you think I should know before I meet with this student

I give my child permission to participate in individual counseling (your e-signature will be your consent) *

Submit

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