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WSD School-Based Counseling Referral Form
The Marathon County School-Based Counseling Consortium comprises of nonprofit and for-profit mental health
clinics, public school districts, and community organizations. Consortium counseling agencies are able to provide on-site mental health counseling to students in all Marathon County public schools.
If you would like to refer your child for school-based counseling or would like more information, please complete the questions below and a representative from your child's school will contact you.
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Date:
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MM
/
DD
/
YYYY
Student Name
*
Your answer
School
*
Choose
Wausau East
Wausau West
Horace Mann
John Muir
Enrich.Excel, Achieve (EEA)
Riverview
Franklin
Hawthorn Hills
John Marshall
Hewitt Texas
Lincoln
Jefferson
Maine
Stettin
G.D. Jones
South Mountain
Rib Mountain
Montessori
Wausau Area Virtual Education (WAVE)
PEER
Parent/Guardian Name
*
Your answer
Parent/Guardian Contact Information - phone number and/or email
*
Your answer
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