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ECG Counselling Request
Please ensure all compulsory sections of the form are completed before submitting. We will contact you shortly to arrange for an ECG counselling session. All ECG counselling sessions will be arranged during recess times or between 2.25pm - 3.00pm on Wednesdays. For ECG counselling sessions after 3pm on Wednesdays, please obtain permission from your respective CCA teacher-in-charge, if you have to attend CCA on Wednesdays.
Name of Student(s)
Choose ONE slot: Venue@ We Breathe Room (Next appointment: 02, 09, 16 Jan 2019)
During AM Recess on Wed 23 Jan 2019
3.30pm to 4..30pm on Wed 23 Jan 2019
During AM Recess on Wed 30 Jan 2019
2.00pm to 3.00pm on Wed 30 Jan 2019
3.30pm to 4..30pm on Wed 30 Jan 2019
During AM Recess on Wed 13 Feb 2019
2.00pm to 3.00pm on Wed 13 Feb 2019
3.30pm to 4..30pm on Wed 13 Feb 2019
During AM Recess on Wed 20 Feb 2019
2.00pm to 3.00pm on Wed 20 Feb 2019
3.30pm to 4.30pm on Wed 20 Feb 2019
During AM Recess on Wed 27 Feb 2019
2.00pm to 3.00pm on Wed 27 Feb 2019
3.30pm to 4.30pm on Wed 27 Feb 2019
Brief Description of Issue/Concern
Type of Referral
By Staff (note : please fill in the next section)
Name and Designation of Teacher (if referral is made by staff)
Have you consulted any teachers or counselors before this?
Yes (please answer the next section)
Not applicable (if this form is submitted by a staff of the school)
Name of the teacher/counselor you have consulted before
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