NSSD Referrals to R.E.A.C.H
Please complete and submit this referral form.  This form will be send directly to a R.E.A.C.H team member who will contact the parent/guardian and student listed on the form during school hours to gather information and determine student need and schedule an intake meeting to start counseling services.  

If the student is in need of urgent attention, please contact Somerset County Crisis at 866.611.6467 
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Student Name 

 *
Student Date of Birth  *
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Parent or Guardian Name *
Name and role of individual making referral *
Reason for referral *
When do you need someone to connect with you
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