Merced High Counselor Referral Form
If you would like to refer a student to their academic counselor or to the Crisis Counselor please complete the following form.
Referral to: *
Date: *
Your answer
Name of student: *
Your answer
Student ID # *
Your answer
Student's grade level *
Please check off all of the following that apply: *
Additional comments:
Your answer
Your name *
Your answer
Is it okay to tell the student that you made the referral? *
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