Request edit access
Counselor Referral Form
Please fill out and submit in order to refer a student to see their school counselor.
If after school hours and you are concerned about your student's safety please dial 911.
(Referrals will be read the next school day.)

Mrs. Eaker (A-G) 803-835-3722
Mrs. Davis (H-N) 803-835-3723
Mrs. Causey (O-Z) 803-835-3735
Email address *
Student Name (Last, First) *
Grade *
Person Completing Referral *
Concerns to share with the counselor *
Please write in a brief comment regarding your concern.
Submit
Never submit passwords through Google Forms.
This form was created inside of Fort Mill School District. Report Abuse