Counseling Referral
This form is a request for a student to be seen by their School Counselor.  

Your school counselor is  here to support students with problem-solving areas of academics, friendships, family, mental health, career/college or any other area.

This is a request to connect with your school counselor via in-person meeting or virtual meeting. This request form is not monitored weekday evenings or on weekends.

If this is an emergency (someone is in danger of harming themselves or others), please contact the Redding Police Department for a welfare check at (530) 225-4200 or call 911.

** Counselors will still maintain confidentiality and not share what you say with anyone, unless you give permission or if there is a clear and present danger to you and/or to other persons. **
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Student's First Name *
Student's Last Name *
Student's Grade *
Relation to student? *
First and Last Name of Person Submitting Form: *
Contact Information of Person Submitting Form: *
Reason for Visit: (Select all that apply) *
Important information for Counselor *
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