Parent Referral for Counselor
Please fill out the information below.  The counselor will send a pass for the student when appropriate.  Please know that referrals will only be seen during school hours:  8:00-3:30.  If there is an emergency outside of the school day, please call the Crisis Hotline at #988.
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Student Name  (First & Last) *
Grade *
Referring Person (First & Last) *
Date of Referral *
MM
/
DD
/
YYYY
Please select a reason for the referral. *
Required
Student needs to see the counselor: *
Required
Does the student know you are making this referral? *
Please include any information you think the counselor should know.
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