Parent Referral Form
This form is for parents/guardians to request counseling services and request assistance. Any information shared in this form is for the use of the school counselor and will NOT be kept in the any cumulative files. If the basis for your referral is to report any abuse, neglect, or intent to harm, you are urged to contact the Department of Children's Services at 877-237-0004.  Thank you for helping us better serve our students.
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Email *
Parent/ Guardian Name *
What is the best way to contact you? *
If phone or text, please provide the best contact number.
Student's Last Name *
Student's First Name *
Student's Grade Level *
Which service do you need? *
Counseling Services mean anything related to academics, personal, social/ emotional, or college/ career needs. 

Parent Teacher Conference - You are requesting a formal sit down with your student's teacher(s) to inquire about student behavior and/ or academic progress in the teacher's classroom.                                     

Other needs include food, clothing, hygiene products, school supplies, etc.
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