NHS Counseling Referral
SUICIDAL (DURING THE SCHOOL DAY): If you have an immediate concern, such as a student with suicidal thoughts or self-harm during the school day, contact a counselor or administrator immediately! DO NOT LEAVE THE STUDENT ALONE!
Keep the student with you until someone comes to get him/her.

SUICIDAL (AFTER SCHOOL HOURS): If a student contacts you after the school day (ex: extracurricular activities, social media, email) indicating thoughts of self-harm, CONTACT LAW ENFORCEMENT IN THE STUDENT'S CITY IMMEDIATELY to request a welfare check. You can use Q to provide the student's address and parent contact information. For Norco community, call patrol at 951-776-1099.
Student's First Name *
Your answer
Student's Last Name *
Your answer
Student ID
Your answer
Referred by: *
Your Name & Contact Information *
Your answer
Student's Grade Level: *
Special Programs: (This helps us with data collection.) *
Student's Counselor (by student's last name): *
Academic Performance: *
Required
Attitude: *
Required
Physical Symptoms: *
Required
Attendance: *
Behavior: *
Interventions: *
Required
Student's strengths: *
Your answer
Additional Information:
Your answer
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