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Parent Referral Form
This form allows for parents to refer their child to the school counselor. All of this information is confidential and will only be seen by the school counselor.
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* Indicates required question
Parent Name
*
Your answer
Email or best form of contact
*
Your answer
Student's Name and Grade
Your answer
My child is struggling with:
Personal thoughts/issues
Friends
Family
School Work
Other
Clear selection
Importance of the issue:
Student can wait a few days
Important and Timely
An Emergency
Other
Clear selection
Any other comments or questions
Your answer
Submit
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This form was created inside of Southwest MN Christian High.
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