Student Referral by Parent (Referencia estudiantil por parte de los padres)
If you would like for your child to be seen by the School Counselor, please complete this form. (Si desea que su hijo sea visto por el consejero escolar, complete este formulario.)
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Student Name/Nombre del estudiante *
Last Name, First Name/Apellido, Nombre
Homeroom Teacher/Profesor de aula/Profesora de aula *
Parent/Guardian Name (Nombre del padre/tutor) *
Last Name,  First Name/Apellido, Nombre
Reason for Referral: Academics/Motivo de la recomendación: Académico
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Reason for Referral:  Emotional/Social (Motivo de la derivación: emocional/social)
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He/she needs to see you...(Él/ella necesita verte...) *
More details (Más detalles)
Anything I might need to know in advance. Please include your phone number in case I need to contact you. (Cualquier cosa que pueda resultarme útil saberlo con antelación. Incluya su número de teléfono en caso de que necesite comunicarme con usted.)
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