RVS TK-8 Counseling Referral Form (For Parents/Guardians/Families)

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RVS Parents/Guardians,

Does your student or child need some help from their school counselor? We offer assistance in the social, emotional, behavioral, mental health, academic and college & career readiness. Please share as much information as possible so we can understand how to best help your this student/child.

Mental Health Concern?

If you would like to refer the student to SAP services (mental health therapeutic counseling), please complete a referral form link below. For urgent matters, complete a RAPID referral and for non-urgent matters complete a GENERAL referral form. (Processed only during school hours. If you need to talk NOW, see #'s below! )

SAP Counseling Referral form (GENERAL)

RAPID SAP counseling referral (crisis, immediate need) (RAPID)

REMEMBER: If you're in an emergency, crisis or you're not feeling safe, please let a trusted adult know right away, call 911 or call the National Suicide Prevention Lifeline 988 or Text 988 or do an online chat w/a counselor right now 24/7 live online counseling.

Requests may take up to 1 to 2 school days for School Counselors to respond.
**Weekends/Holidays/Breaks are not included in response time***

Email *

Your name (The adult referring the student) *

Are you a... *

Name of student you are referring *

Student ID Number *

What grade is the student in? *

Please share as many details as possible to provide context for this referral.

What are your concerns for this student? *

Immediate Crisis issues (concern for suicide ideation, self-harm, or immediate need)

Mental Health (anxiety, depression, fear, sadness, confusion, loneliness)

Emotional Development (emotions/maturity/stress/self-esteem)

Behavior (anger/poor choices/discipline issues)

Academic (grades/homework/struggling in class)

Virtual learning (technology issues/distance learning challenges)

Social Stuff (issues with friends, getting along/bullying issue)

Family Stuff (parents, siblings, home life, stress at home)

Resources (food, internet, rent, clothing, financial or supply need)

Engagement (student attitude, mindset, lack of engagement or motivation)

Transition (recent move, divorce, traumatic event, recent death/loss)

Health (child or family health matter impacting them)

Attendance Issue (Student is often tardy/absent)

Personal (I'd rather share with you privately, contact me before the student)

Motivation (having positive energy towards accomplishing goals)

Other:

Required

Which counselor do you want to refer the student to? *

Your best contact # if we need to consult? *

Parents-how do you prefer for us to respond?

Please check in with my student during the school day

I want a parent phone call

I want a parent conference w/the counselor only

I want a parent conference w/my child & the counselor

I want a parent/teacher/counselor meeting

Other:

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THANK YOU for submitting this counseling request. School Counseling office hours are Monday - Friday from 8am-4 pm. IF THIS IS AN EMERGENCY/CRISIS SITUATION PLEASE CALL 911 or refer the student to the resources below! The new crisis line is 988 (call or text) or click Click for Live Online Counseling 24/7 It may take up to 3 days for a response to this request due to our student caseload.

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