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Counselor Referral 2024-2025
Please use the questions below in order to make a self referral for Mr. Cooper. This form will be used to organize appointments and schedule meetings.
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Email
*
Your email
First and Last Name
*
Your answer
What is your referral concerning?
*
Choose
I wish to talk to a counselor about mental health.
I have a question about my schedule or classes.
I have a question about college or my future career
I need to ask about resources (Food, Clothing, WIFI At Home, etc.)
I need to report something.
I need to talk to an administrator
Other
If you listed "Other" or had a different concern, please provide a little context in the box below.
Your answer
When do you need to speak to someone regarding your request?
*
Choose
As soon as possible.
Today.
Preferably today, but tomorrow at least.
Whenever you can.
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