CAHS Social Emotional Counseling Referral Form
Please complete this CONFIDENTIAL form. Ms. Hughes will reach out to you through Schoology to schedule an appointment of your choice with 24 “school” hours (Monday-Friday 8am-3pm)

For your Academic Counseling needs please reach out, either through email or Schoology, to Mrs. Mauhili (A-L) Mrs. Withem (M-Z) via Schoology or email.
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Name (First and Last) *
Person Referring *
Reason for Appointment *
Level of Importance *
If this is an emergency, seek out the nearest adult or call 911. If you or someone you know wants to hurt themselves the National Suicide Prevention Lifeline 1-800-273-TALK (8255)
Non Crisis (just a check in/chat)
Immediate Concern for Self or Others
Best time for Student *Note, student must not have a scheduled live class at time of appointment. *
Required
I prefer to meet via *
Required
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