Small Group Counseling Referral Form

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The purpose of small groups is to bring students with similar needs or concerns together to share, problem solve, and connect with their peers to enhance their social and emotional development. Small group counseling is available to all students. Groups typically range in size from 4 to 8 students and meet 6 times total during the normal school day. For more information about the small groups offered, please reach out to Katrina Johnson, School Counselor at Pine Forest Elementary. E-mail katrina.johnson@humbleisd.ne t or 281 641-2107

Email *

Parent Name *

Parent Phone Number or Email *

Student Name *

Grade level *

Pre-K

Kindergarten

1st grade

2nd grade

3rd grade

4th grade

5th grade

SPEAK

Other:

What small group do you think your child needs? *

Optimistic Thinking

Self-Management

Goal -Directed Behavior

Relationship Skills

Decision Making

Personal Responsibility

Social Awareness

Self-Awareness

Grief & Loss

Relationship Skills

Friendship

Anxiety

Making choices/Behavior

Family situation

Restorative Circle/Conversations/Practices

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