HOA Counseling Referral
Use this confidential form to request to speak with one of the School Counselors, Kenneth Ollis or Annette Snyder, or the Wellness Counselor, Sara Stollberg. Staff also use this form to make referrals.
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If this is a mental health emergency please contact the Washington County Crisis line/Hawthorne Walk In-Center at 503-291-9111 (24/7). You may also call the National Suicide Lifeline at 1-800-273-8255 or text 741741.
Name of referring person (first and last) *
Student name (first and last) *
Student Grade *
Student ID (if you know it)
I am: *
Please explain your concerns (please be specific) *
Email address *
Phone Number
optional but preferred
How do you prefer to be contacted?
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FOR STAFF ONLY: What steps have already been taken? (talked to student, talked to parent, academic support, ect)
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