Student Services Referral Form
This form will be viewed by Albemarle Road Middle School Student Services staff members. It will be checked during our office hours: Monday-Friday 8:00a.m. to 3:30 p.m. Please keep in mind that this form is not meant for emergencies. If you need to speak to someone immediately, please contact us via phone. If you or someone you know is in crisis after hours and there is a need to speak to a mental health professional, please see below for a list of resources available in the community.

Crisis Services (24 hours/ 7 days)
Mecklenburg County 24-hour Crisis Line (Free) 1-800-939-5911
Mobile Crysis 704-566-3410 Option 1 (Free service that will come to your location)


Este formulario será visto por los miembros del personal de Servicios Estudiantiles de Albemarle Road Middle School. Se verificará durante nuestro horario de atención: de Lunes a Viernes a las 8:00 a.m. a las 3:30 p.m. Tenga en cuenta que este formulario no está destinado a emergencias. Si necesita hablar con alguien de inmediato, contáctenos por teléfono. Si usted o alguien que conoce está en crisis después de horas y necesita hablar con un profesional de la salud mental, consulte a continuación la lista de recursos disponibles en la comunidad.

  Servicios de crisis (24 horas / 7 días)
  Línea de crisis las 24 horas del condado de Mecklenburg (gratis) 1-800-939-5911
  Mobile Crisis 704-566-3410 Opción 1 (Servicio gratuito que llegará a su ubicación)



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Email *
Date  of Referral *
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DD
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YYYY
Referral Source *
First Name *
Last Name *
Student Name
Student Grade Level *
Telephone Number *
Reason for request/Summary of situation (Non-Emergency) *
If this is an emergency during school hours, please call the grade level school counselor or social worker. If after hours, please contact the crisis numbers above.
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