Mrs. Fairman's School Counselor Student Referral Form

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Thank you for writing to me. I love supporting you and look forward to helping in any way that I can.

If you are a student, I will reply to you by email or pull you from class during an appropriate time.

If you have an immediate need to see a counselor due to an emergency or safety concern, please express this to an adult now.

First Name *

Last Name *

I need to see or speak to my School Counselor because (please elaborate) *

(Optional) If this concern involves bullying or harassment, please elaborate. Please understand that this could be reported to your grade level administrator. Please include how you would like this resolved.

I look forward to supporting you this school year - Mrs. Fairman

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