Student Referral Form
Complete the following form for a counselor referral. This is for non-emergent situations. Contact your school counselor via phone or email for emergent situations ASAP. Please answer ALL questions, so Mrs. Swisher knows who you are and what class you are in. If someone is hurting you, you want to hurt yourself, or you want to hurt someone else, tell a trusted adult right now. Do not fill out this form. 
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What is your name?
What grade are you in?
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Who is your teacher?
What do you need to talk to Mrs. Swisher about?
What is the size of your problem?
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