FMHS Student Referral for Counseling Support
This form is for parents, teachers, and students to refer a student (or themselves for students) to see their school counselor.

This form is for non-urgent needs.  The responses will not be monitored in the evening or on weekends.  The times that counselors can view the forms each day may vary as well.  Each counselor will do their best to respond to the request and contact students in a timely manner.

If you have an emergency situation, such as someone being in danger of harm to themselves or someone else, please contact the police or dial 911.  

Counselors will maintain confidentiality unless there is danger to someone else or the student gives permission.  
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Email *
What is your last name? *
What is your first name? *
What is your relationship to the person being referred? *
What is the last name of the student? *
What is the first name of the student? *
What grade is the student in? *
What is the referral for? *
Required
How quickly do you need to be seen? *
Would you like to talk with your counselor or Mr. Young, our Career Development Facilitator? *
Is there any additional information you want us to know before talking with you? *
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