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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: 28 Mar 2018)
During AM Recess on Wed 09 May 2018
3.00pm to 4.00pm on Wed 09 May 2018
4.00pm to 5.00pm on Wed 09 May 2018
During AM Recess on Wed 16 May 2018
4.00pm to 5.00pm on Wed 16 May 2018
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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