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2023-2024 Referral for Counseling
Referral form for school staff or parents/guardians who would like to refer a child to the school counselor.
FOLLOW-UP FOR ALL REFERALS WILL BE ANSWERED BY SUBMISSION/URGENCY OF REFERRAL.
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* Indicates required question
Student's Name (First & Last)
*
Your answer
Referred by/Homeroom Teacher:
*
Your answer
Explain your reason for your referral (***Please include any important information you need for me to know)
*
Your answer
Have you contacted the parent about this incident and let them know you are referring them to the counselor?
*
Yes
No (please contact the parent prior to submitting a referral)
Is this a crisis (a student threatening to hurt themselves?)
Yes ----> Call counselor/front office and walk student to the office (do not leave unattended)
No, this is a non-emergency. (Student will be seen as time comes available)
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