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Student Referral to Counselor (For Parents)
Please complete this form if you are seeing a need for your child to talk to the school counselor. Mrs. Miller will contact your student at the most convenient time.
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* Indicates required question
Student's First Name
*
Your answer
Student's Last Name
*
Your answer
Student's Grade
*
6
7
8
Student's Academy
*
Trailblazers
Victory
Discover
The Rock
Referring Parent's Name
*
Your answer
Reason for Referral
*
Your answer
How would you rate the timeframe for this student's needs to be met?
ASAP- this is an emergency
Pretty urgent- this needs to be seen within the next day or so
Whenever you find time- this can be handled within the week
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