Walteria Parent/Guardian Counseling Referral Form
Parents / Guardians, 

Thank you for reaching out! If you would like to request that your student be seen by the school counselor for short-term, school counseling services, please complete this form.  
This form is intended for non-crisis school counseling referrals. Referrals will be prioritized by the level of urgency and responded to as soon as possible.

Please keep in mind that:
  • School Counseling is brief and solution focused, typically lasting 6-8 sessions.
  • Not all students referred will receive school based services.
  • Some may be referred to outside therapeutic support.
If you would prefer to discuss your concerns beforehand, you may also schedule an appointment: https://calendly.com/nguyen-helen 

For other inquiries, please email nguyen.helen@tusd.org
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Email *
IMPORTANT NOTE:
If this is an EMERGENCY and you do not have immediate access to the counselor, please call 911, and/or contact the Suicide Prevention Lifeline at 9-8-8.
Your Full Name: *
Student's First and Last Name: *
Grade: *
What is your relationship to the student? *
Please specify below:
Is the student aware of the referral? *
How urgent is this matter?
 *
Academic Reason(s) for Referral *
Check all that apply.
Required
Social-Emotional Reason(s) for Referral *
Check all that apply.
Required
Please provide a summary of your concern(s): *
I understand that School Counselors do not provide therapy or long-term counseling (however, they are prepared to recognize and respond to students' social-emotional needs and to assist students and families seeking support and resources). *
Required
Thank you! The counselor will follow-up with your request as soon as possible.
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