Apison Contact School Counselor
Disclaimer: The information you provide is privileged and will go to the school counselor alone when you submit. In any counseling situation confidentiality is maintained except:
1. In case of suspected abuse or neglect
2. If a child poses a danger to self or others
3. The child, parent, or guardian gives permission to share
Referrer is a
Student Name *
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Teacher Name *
Grade Level *
Your Name
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Email Contact Information
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Please explain your concern:
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What has been tried before? What was the result?
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Have parents or teacher been contacted? If so what was the result?
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Best time to reach out to student (teachers only)
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