Appointment Request or Referral to Mrs. Cheff

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To make a referral or request an appointment with Mrs. Cheff, RHS School Counselor, please fill out the information below. If this is an emergency (suicidal thoughts or actions, fear of harm by self/others, etc.) please seek help immediately from another trusted adult. If this is an emergency outside of school hours, call 911.

I am *

A Student Referring Myself

A Student Referring Someone Else

A Parent/Guardian

A Teacher/Staff Member

Other:

Student's Last Name *

Student's First Name *

Name of Referring Person (if not self)

Student's Grade Level *

9th (2023)

10th (2022)

11th (2021)

12th (2020)

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