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Referral to Mrs. Wilson-Thompson/Mrs. Panion
To make a referral or request an appointment with a counselor, please fill out the information below. If this is an emergency (suicidal thoughts or actions, fear of harm by self/others, etc.) please go to the counselor or other trusted adult immediately. If this is an emergency outside of school hours, call 911.
A Student Referring Myself
A Student Referring Someone Else
A Teacher/Staff Member
Student's Last Name
Student's First Name
Name of Referring Person (if not self)
Your Contact Email
Best time to contact you to make an appointment
Low-Schedule when available
Medium-Sooner rather than later
High-As soon as possible
Reason for appointment
Please check all that apply
Grades and School Work
Teacher/Other Adult Concerns
Relationships and/or Sexuality
Please briefly explain if you can:
"I'm struggling with homework", "fight with friend", "scholarship questions"....
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