Counseling Referral Form

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Counseling Referral Form

This form is for any staff member or student to refer a Richmond High School student to the school counselors.
We will not be sharing this information with the student you refer, we ask for your name in order to reach out to you if we have questions.

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* Indicates required question

Your Name:

Your answer

Today's date: *

MM

/

DD

/

YYYY

Are you referring yourself or someone else? *

I am referring myself.

I am referring someone else.

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