LTS HUGSS Referral Form

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LTS HUGSS Referral Form

**PLEASE SUBMIT YOUR RESPONSES BELOW THE INSTRUCTIONS IN THE BLANK SPACES PROVIDED**
Submit this form to request a brief check-in and referral for counseling if needed

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* Indicates required question

Email *

Your email

Please list student name below: *

Your answer

Please type your name (person referring) below:

Your answer

Please type email for person referring below:

Your answer

Please share your concerns below: *

Your answer

Submit

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This form was created inside of Humboldt Unified School District.

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