Counseling Referral Form
When should you complete this form? If you or somebody you know needs help. This can be academic problems (struggling academically, note taking, organization, time management, test taking etc.), personal problems ( trouble at home, parents divorce, grief/loss, stress, social skills, trouble with friends, self-esteem, self-harm etc.) or if you want to talk about high school planning and post-secondary options. If you think that somebody else needs help, you can also refer them anonymously. A link to this form is also on our website www.thegroveschool.org

PLEASE NOTE:

YOUR EMAIL IS NOT BEING RECORDED WHEN YOU SUBMIT THIS FORM.

IF YOU OR SOMEONE YOU KNOW NEEDS IMMEDIATE ASSISTANCE, TALK TO ANKE IN PERSON IMMEDIATELY.

Are you a
Student that needs assistance:
Your answer
Your name (If you want this referral to be anonymous, leave this question blank):
Your answer
Areas of Concern
Briefly explain your concerns
Your answer
Submit
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