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Counseling Referral Form 2022-2023
To be completed by a parent/guardian.
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Counseling Information
Counseling MAY be beneficial for students who struggle with:
Behavior
Emotions
Peer Relationships
Family Changes
Academics
Motivation
Social Skills
...and a variety of other life situations....
Counseling Referral Procedure
1) Complete the online referral found on the St. Marcus website or contact Kirsten Ellard via phone (262-349-3733).

2) Kirsten will collaborate with you about your concerns and discuss the options available for your student.

3) Kirsten will complete a classroom observation and/or communication with Special Education/Deans/Directors about level of intervention needed and/or available for the student.

3) Communication/Collaboration with teacher regarding intervention plan & data tracking
*If individual counseling or small group intervention is decided upon:    
     a) Teacher may complete a referral as well (if applicable)
     b) Corresponding permission forms will be sent home & need to be returned before counseling can begin
     c) Strengths and Difficulties Questionnaire completed by teacher/parent/student (if applicable)
     d) Kirsten will coordinate counseling schedule in collaboration with classroom/student schedule & communicate with teacher/adviser.

4) Follow-up communication between the teacher, advisor, counselor, parent, and admin will be expected throughout the intervention.

*note: some steps may change depending upon severity and/or historical needs of an individual student


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