Raymondville ISD Referral Form for School Counseling Services for RISD Students
Please fill out the referral form if you (the parent) would like his/her school counselor to speak to your child or if you (the student) want to speak to a school counselor. We will receive the referral and get back to you as soon as we can.
*NOTE: A school counselor will be available to speak with students regarding areas of their academic, behavioral, social and emotional needs. At times, a counselor may have to refer child to outside agencies.
Moderate (Schedule When Available)
High (ASAP) - if this is an emergency, please stop and call 911.
School and School Counselor
L. C. Smith Elementary (Mrs. Jennifer Zamorano)
Pittman Elementary (Mrs. Diana Gomez)
Myra Green Middle School (Mrs. Marisol Herrera)
Raymondville High School (Mr. Sergio Martinez)
Raymondville High School (Mrs. Beatriz Salinas)
Raymondville Options Academic Academy (Mrs. Erma Guerra)
Student First Name
Student Last Name
Parent Phone Number or House Phone
Best Way to Contact Child
Phone Call (Using House Phone or Parent Phone Number)
Google Meet or Zoom Meeting (Virtual Meeting like Facetime)
Best Time to Make Contact (between 8 am - 4 pm)
Best Dates to Make Contact (please provide 3 days in case other appointments are scheduled for the date requested)
REASONS FOR REFERRAL (select all that apply)
Low Self-Esteem/Negative Self-Talk/Low Confidence
Anger Management/Low Frustration Tolerance
Stressed/Needs Coping Strategies
Hyperactive and/or Inactive
Lack of Self-Control/Impulsive
Bullying or is Being Bullied
Poor Social Skills
Few or No Friends
Conflict with Other Students/Peer Issues
Lack of Motivation/Not Completing Classwork
Help with College Applications
Help with College Scholarships
Help with Transcripts
Help with Test Scores
Help with College Classes
Drug or Alcohol Abuse in the Home
Abuse (Physical, Emotional, or Sexual)
Parent has been contacted
Student has met with other professionals
Extra adult attention has been given
There has been a student conference
Incentives/rewards have been increased
There have been modifications/accommodations
Any other concerns you may have, please let us know.
List of Resources and Phone Numbers for Support Lines
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This form was created inside of RAYMONDVILLE INDEPENDENT SCHOO.