School Counselor Referral Form 2025-2026

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Hello & welcome back to another new school year! We are so glad you are here, and it's going to be a great year! Ms. Ervin works with all 8th grade and 7th grade UNCC Team while Mrs. Yang works with all 6th grade and 7th grade NC A & T Team. They are school counselors who are here to help and support students' social/emotional, academics, and career needs. Please complete this form to let them know how they can help this school year.

Students: Complete this form for yourself if you want your school counselor to reach out to you.

Parents/Guardians: Complete this form if you want a school counselor to reach out to your child on specific concerns you may have.

School Staff: Complete this form if you want a school counselor to reach out to a student you have concerns about.

YYYY

I am... (choose only one from the box below)

A student

A parent/guardian

A school staff

Clear selection

Name of person making this referral *

Name of student (first & last) who needs to be seen *

Grade level of student *

6th grade

7th grade

8th grade

Reason (s) for making this referral: (You can check more than one box!) If other, you can type what it is next to that line. *

School (grades, organizational skills, study habits, motivation)

Feelings (anger, sadness, worry, nervous, etc...)

Home/family problems

Behaviors (bullying, self-control, decision making skills)

Friendship problems (drama, gossip, rumors)

Hygiene

Check in

Other:

Required

Submit

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