Telehealth Counseling Program-Referral Form

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Many students are struggling as a result of the impact of COVID. Mental health concerns continue to be an issue. The district is offering counseling services that extend beyond the school day. Use this form to refer your child if they could benefit from additional counseling support. Please know this is short term counseling to help support those students who are struggling. Your child would be invited to participate in after school counseling provided by one of mental health counselors who works in the School District of the Chathams. The counseling session will take place virtually during after school hours. The meetings would focus on the following area:
Problem solving skills
Coping Skills
Resilience training

Your name

Primary phone number to contact you

Email for contact

Your child's name

School your child attends

Southern Boulevard School

Milton Avenue School

Washington Avenue School

Lafayette School

Chatham Middle School

Chatham High School

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Briefly share the reason for the referral and how counseling could help your child

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