MVHS Student Support Referral Form
MVHS Students, Families & Staff,
The Counseling Department is here to help support students and families. Our top priority is the health, safety, and well-being of every MVHS student and family.
Should you have a concern about an MVHS student or if you, as an MVHS student, would like to refer yourself, please complete this form. The Counseling Dept. will make sure to follow up with any students and/or their families to make sure we are providing the needed assistance.
Please note that these responses are checked during designated school days and it may take 1-3 days to follow up with a student and/or family.
Should you feel that you need immediate non-life-threatening support please contact the Access and Crisis Line at 888.724.7240 or if you need life-threatening support please call Emergency Services at 911.
In addition, VUSD has extra resources that can be found on this link:
Referring Party Information:
Please fill in as much information as possible. Should we need more information it is often extremely helpful to be able to contact you.
Referring Party Name First and Last (Person making the referral)
Referring Party contact information:
In case we need more information, what is the best phone number or email to contact you at?
Your affiliation with the student being referred:
Self Referral (I am referring myself)
Teacher Referral (I am the teacher of the student)
Parent Referral (I am the parent of the student)
Peer Referral (I am a friend of the student)
Student being referred:
Please fill in as much information as possible.
Student Last Name
Student First Name
Current Grade of Student
Student's phone number?
Concern about student
Please check all that apply:
Nutrition /Food Concern
Would the student being referred prefer to be contacted virtually or would they like to be able to get services in person?
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This form was created inside of Vista Unified School District.