Counselor Referral Form
Please complete this form to request an appointment to meet with Mrs. Crews.  Please allow 24 hours for a response. Mrs. Crews will send your appointment time via email, so be sure to check your email. Feel free to email Mrs. Crews if you haven't received a response within 24 hrs.
Sign in to Google to save your progress. Learn more
Email *
Student Name *
Who is making the referral? *
Required
Grade Level of Referred Student *
Is this an emergency? *
Examples of emergencies: (Suicidal ideation, abuse/neglect, important deadlines...) In the event of an emergency, have your teacher find Mrs. Crews or an administrator immediately! If the emergency is after hours, call 911 or the Mobile Crisis Hotline at (866)275-9552
Reason For Referral *
Required
What steps have you taken to address your concern? *
List your time of availability *
Make sure your availability does not conflict with your class schedule!
Are you willing to participate in a group meeting with students of the same interest? *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Cabarrus County Schools. Report Abuse
Google Forms