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Counseling Referral Form
Complete this form to request assistance from a counselor. This information is confidential and will ONLY be seen by the CMS counselors. You can also contact our office by calling 912-729-3113 or
akennedy@camden.k12.ga.us
,
rswain@camden.k12.ga.us
, or
lcsmith@camden.k12.ga.us
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Student ID
Your answer
Student's Last Name
*
Your answer
Student's First Name
*
Your answer
Student's Grade
*
6th
7th
8th
What can we help you with?
*
Report a problem
I would like a counselor to contact me
Required
Please describe how we can help you.
*
Your answer
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