Owens Elementary School Counseling Referral
Once you complete and submit the form an email will be sent directly to the counseling center. The student will be added to their list of students to see.
**If the presenting problem is dealing with some type of harm that qualifies as an emergency (the student is being harmed by someone, the student is planning to harm someone else, or the student is self harming) secure the student then please contact a counselor/administrator via phone AND this form.
If the student is being abused in any way please contact CPS immediately, remember you have 48 hours to report suspected or possible abuse.** 1(800) 252-5400
Your Email Address
Student First Name
Student Last Name
Reason for Referral
Family Member in Jail/Prison
Any additional information that I may need to know...
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service