VVJH Counseling Referral Form
Parents and teachers, please feel free to fill out this form if you would like to refer a student for guidance or academic counseling with the counselor. Students may also utilize this form to request guidance/academic counseling for themselves.
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Email *
Requestor First and Last Name (IF referring a student)
Student First and Last Name *
Grade Level *
Student needs Social/Emotional Support and/or Mentoring with the following: *
Required
If you feel the child is in danger and/or it is an emergency, please contact 911 or your local law enforcement agency immediately. Please see other helpful resources below:
1) National Suicide Prevention Lifeline : 1-800-273-8255
2) Texas Abuse Hotline: 1-800-252-5400
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