Wilson Social Work Request Form
Please fill out this form completely.  

This form is a request and does not guarantee services but gives us information to find the most effective way to provide support.  

Our social worker provides one-on-one counseling with students, meets with parents for support, leads student small group lessons focusing on social & emotional learning, and connects families to community resources. 

-Principal Markworth (Eric.markworth@loganschools.org)
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Parent/Guardian Name: *
Parent/Guardian Email:  *
Parent/Guardian Phone Number: *
Student Name: *
Grade Level: *
Brief description of reason for referral: *
Would you prefer individual or group services? *
Is the student receiving outside therapy or services? *
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