Castleberry ISD Counseling Referral
Use this form if you know of a Castleberry ISD student you believe needs to visit with a school counselor
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電子郵件 *
Your Name
Student Last Name *
Student First Name *
Student Preferred Name
Student ID # (if known)
Student Grade Level
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Do you suspect this student might be at risk for suicide? If this child has made an outcry of suicidal thoughts, please seek help immediately by calling the National Suicide Prevention Hotline at 1-800-273-8255.  If you feel this child is in immediate danger, please seek immediate medical attention, or call 9-1-1. *
Do you suspect this student might be a victim of physical or sexual abuse or neglect?   *
How do you know this student? (choose one) *
What is your primary area of concern? *
If your concern is ACADEMIC, please select all that apply to give us more information
If concern is BEHAVIORAL, please check all that apply in order to give us more information
If concern is SOCIAL/EMOTIONAL, please check all that apply (some might overlap with Behavioral)
Is there a different issue that you would like a Counselor to address with this student?  If so, please let us know more:
Please share any additional details about your concern, and whether or not you would like for the Counselor to share who made the referral.
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