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Wilson Social Work Request Form 25-26
Please fill out this form completely.  

This form is a request and does not guarantee services but gives us information to find the most effective way to provide support.  

Our social worker provides one-on-one counseling with students, meets with parents for support, leads student small group lessons focusing on social & emotional learning, and connects families to community resources. 

-Principal Markworth (Eric.markworth@loganschools.org)
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Adult requesting help:
 *
Parent/Guardian Name:  *
Parent/Guardian Email:  *
Parent/Guardian Phone Number: *
Student Name: *
Grade Level: *
Brief description of reason for referral: *
Would you prefer individual or group services? *
If group services were selected, which class(es) do think this student would benefit from?

Social Skills will cover communication and listening skills, following instructions, participating in social settings, and problem solving in social situations..

Emotional Regulation will cover the zones of regulation that will help students be able to self-regulate and control their emotions..

Resilient Mind Skills will teach 4 foundational skills including mind mapping, sensory awareness, recognizing requirements and small mind stories. We have found students greatly benefit from these skills.
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Required
Is the student receiving outside therapy or services? *
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