School Counseling Referral Form- Glenwood ES - For Parent/Guardian to complete...
Thank you for your interest in School Counseling at Glenwood and completing and submitting this form. Please note that school counseling is designed for students who may need support due to circumstances that are distracting them from their learning and ability to focus in the classroom(physical or virtual) classroom setting.  If there are circumstances that do not impact the student's learning, you may request a brief check in from a school counselor, but then it will be the parent/guardian's responsibility to look for more intensive counseling outside of the school.  Please access the Counseling Team's website: https://sites.google.com/view/glenwoodcounseling/home so you can learn more about who we are and what we do and to also see a list of counseling resources in the community.  
We look forward to connecting with you soon!  
Michele and Stephen
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Date of Referral *
Parent/Guardian Name: *
Name of Student, Grade Level, and Teacher Name: *
Contact Information:  (phone number, email address) *
Who does the child live with? *
If divorced, is there 50/50 custody?   *
Reason for Referral (check all categories that apply) *
Briefly describe why you are completing a school counseling referral: *
Which interventions have been tried already? *
Required
Is this student currently participating in any other service(s)? (ex: Speech, OT, Resource)  If yes, please describe the service(s). *
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