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Group Support Referral - Horizons K-8
Please complete if you would like Sherry (licensed school counselor) and/or Jeremy (licensed professional counselor) to support your child with academic, social, and/or emotional needs.
Your Student's Name (First and Last)
Your Email Address
Your Phone Number
Your Student's Teacher's Name (homeroom or advisory)
How urgent is the need for your child?
URGENT but not a crisis (My child needs support ASAP)
NOT URGENT (My child can wait for next availability)
NO ACTION NEEDED (Just wanted to keep you in the loop)
Do you have specific concerns about your student at this time?
Would you like your child to participate in small group counseling?
Which group would be of benefit to your student?
Relationship Skills: Friendship / Peers
Relationships: Changing Families (blended families, adoption, divorce, other)
Self-Management: Grief / Loss Concerns
Self-Awareness: My emotions, anxiety, fears
Self-Management: Self-esteem, stress management, empowerment
What other information is important for us to know about your student? Thank you!
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