WUSD Elementary School CARE Team Counseling Referral Form
             ⚠️   ⚠️   ⚠️   🔴   IMPORTANT   🔴   ⚠️   ⚠️   ⚠️    

Please read this message before proceeding with this form:

If you suspect child abuse or neglect, call child protective services at 800-540-4000.

If you suspect or know a student is in immediate danger to self or other(s), call 911.

        🟢   After reading this message, proceed when ready   🟢    
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Email *
✨ Hello! Thank you for reaching out to your school counselor team =) In order to best support you, please take a moment to fill out this form. This form can be filled out by a student, staff, or parent/caregiver. We look forward to hearing from you and collaborating. You will receive an automatic response after your submission, which will include a PDF version of your referral. 
                         
Name of student being referred (Last name, First name): *
Access Code (5 digits):
Student's school: *
School Year *
Counselor Information by School Site
Aviation Elementary School: Sofia Borbon: sborbon@wiseburn.org
Del Aire Elementary School: Sandy Suarez: ssuarez@wiseburn.org
Del Aire Elementary School (School Psychologist): Dianna Castellanos: dcastellanos@wiseburn.org
Hollyglen Elementary School: Anaiss Gutierrez: agutierrez@wiseburn.org
Email address of school counselor:

 *
Student's grade: *
Name of student's teacher:
What are the student's strengths? *
What social-emotional and/or mental health concern(s) do you have about the student? *
On a scale of 1 to 10, how serious is what is being experienced (1 = not that serious / 10 = VERY serious)?
 *
Not that serious
VERY serious
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