School Counselor Support Referral form (Students)

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School Counselor Support Referral form (Students)

If you wish to speak with a counselor, please fill out this form. A counselor will reach out to you within 48 hrs.

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* Indicates required question

Email *

Your email

First and last name *

Your answer

Grade *

6

7

8

Reason For Referral *

Your answer

When do you need to see a counselor? *

It is URGENT (the student has signs of distress, self harm or suicide ideations)

It can wait (counselors will call in the student within 48 hrs)

Counselor you would like to meet with if they are available. *

Ms. Smith

Mrs. Carrio

Ms. Andrade

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