A.V. Cato Elementary | AVC Counseling Referral Form (Website)

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AVC Counseling Referral Form

Who would you like to speak with? *

Mrs. York (Counselor)

Mrs. Gradel (Soical Worker)

First Available

I am a *

Teacher

Student

Parent

Student First and Last Name
*

Student Homeroom Teacher
*

Please share what you want to talk about
*

If you are experiencing friendship issues, have you asked the teacher to do a Restorative Circle to help you? If not, please talk to your teacher before submitting the form. If you have already participated in a circle and the situation has not improved, please complete the rest of the form.
*

Yes

How important is your need to speak to me? We will come get you as soon as we are available.
*

1- Important, but it can wait

5 Very Important- ASAP

Submit

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