Referral to Ms. Marie
To make a referral or request an appointment with the counselor, please fill out the information below. If this is an emergency (suicidal thoughts or actions, fear of harm by self/others, etc.) please go to the counselor or other trusted adult immediately. If this is an emergency outside of school hours, call 911.
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Email *
I am *
Required
Student's Last Name *
Student's First Name *
Name of Referring Person (if not self)
Your Phone
Best time to contact you or make an appointment?
Priority *
Reason for appointment *
Please check all that apply
Required
Please explain if you can:
"I'm struggling with homework," "fight with friend," scholarship questions," etc.
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