Counselor Referral - From Parent or Guardian

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Please fill out this form to refer your child to see the counselor. These referrals will be reviewed daily, however if your child needs immediate or same day attention, please also call me at 704-961-3900 or call the office and they can request attention from a member of our student support team.

Email *

Referring Adult Name and Preferred Contact Method (If phone, please include best phone number) *

Child's Name *

Brief Description for Referral

Is their classroom teacher aware of their need and/or reason to meet with me? *

Are their any other details you'd like to share with me?

Send me a copy of my responses.

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