Counseling Group Referral

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Complete this form if you are interested in having your child participate in one or more of the following counseling groups. Based upon the needs and schedule, groups will be formed throughout the year. Before a group begins, students will be given a permission slip that must be signed in order to participate in the group.

Your Name *

Student Name *

Student's Grade Level *

Which topic(s) for a group would be best? *

Anger management

Attention games/focus

Organization/Executive Functioning

Problem Solving skills

Understanding/Identifying Emotions

Self-regulation

Relaxation/coping skills

Self-esteem/confidence

Social Skills/Friendship

Required

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