Caregiver Referral for Student Support Services 2024-2025
This form is for parents/guardians to request support services for you child/family. This referral will be received by our School Social Worker, Amanda Greenwood and the School Counselors, Bailey Winchester(K-2nd) and Danielle Williams(3rd-5th). Any information shared in this form is for the use of the school counselors/social worker and will NOT be kept in the any cumulative files. Thank you for reaching out! Versión en español - Haga clic aquí

School Counselors differ from mental health counselors in that we provide systemic support to all students through classroom lessons, small groups, and short-term, solution-focused counseling. Mental Health Counselors provide individual counseling sessions and function as long term therapy.

School Social Workers have access to community resources that may be helpful to your child/family. She is also available to assist families with attendance issues.

At times, the counselor, social worker, and school-based staff (teacher, principal, etc.) will need to exchange information about your child (how are they coping in class, strategies to help, etc.) All communication will take place only on a need-to-know basis.

If the basis for your referral is to report any abuse or neglect, you are required by law to contact the Department of Children's Services at 877-237-0004 (https://carat.app.tn.gov/carat/). If this is a crisis call 911 or go to your local emergency room. 
Sign in to Google to save your progress. Learn more
Caregiver Name *
Student's Last Name *
Student's First Name *
Grade Level *
Teacher's Name *
What category best describes your child's need? *
Required
Does your family need help with? *
Required
Please share in a few sentences any background information that initiated this referral. *
I would like the school counselor/social worker to *
Required
Please provide the best way to reach you. (Call, Text, Email) Please provide telephone number or email. *
Is there anything else you need the school counselor to know?
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Knox County Schools.

Does this form look suspicious? Report