Elsa England Counselor Referral Form
Thank you for reaching out to the Elsa England counseling team!  To better help you and your student, please answer the questions below as best as you can.  Please allow 24 to 48 hrs for a response.  We will respond to referrals in the order that they are received.  If this is a crisis or an emergency, please contact the front office directly for immediate support.  
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I am a... *
Your first and last name *
Contact information *
Name of student being referred *
Grade level *
Student's homeroom teacher *
Have you notified the homeroom teacher? *
Have you notified parents/guardians that the student is being referred for counseling services?  *
Is the student currently receiving SPED services? *
If the student is receiving SPED services, have you been in contact with the campus LSSP (Licensed Specialist in School Psychology)? *
Student needs helps with... *
Required
Size of the problem *
What have you tried so far? *
Additional notes helpful for Mrs. Uribe, Mrs. Johnson , Mrs. Washington :to know (background info/ description of concerns, etc.) *
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