Parent Request for Assistance from School Counselor
***School counselors provide support for students who's social-emotional needs are impacting their educational attainments or their peer interactions. School counselors are not licensed therapists. The school counselor can check-up on students experiencing emotional difficulties, but will refer out to community-based mental health services for on-going therapy. Therapeutic needs (such as coping with major life changes, or managing severe anxiety or depression) are best addressed by mental health therapists. Our Family Advocate can help with accessing community mental health services.
Email *
Student Name
Nombre del estudiante
 *
Teacher Name
Nombre del maestro
Grade *
Who is requesting the support?

¿Quién solicita el apoyo?
 *
Reason for Referral
***School counselors provide support for students who's social-emotional needs are impacting their educational attainments or their peer interactions. School counselors are not licensed therapists. The school counselor can check-up on students experiencing emotional difficulties, but will refer out to community-based mental health services for on-going therapy. Therapeutic needs (such as coping with major life changes, or managing severe anxiety or depression) are best addressed by mental health therapists. Our Family Advocate can help with accessing community mental health services.

Motivo de la derivación ***Las Counsejras escolares brindan apoyo a los estudiantes con necesidades socioemocionales afectan su rendimiento académico o sus relaciones con sus compañeros. Las Consejera escolares no son terapeutas titulados. El orientador escolar puede dar seguimiento a los estudiantes que experimentan dificultades emocionales, pero los derivará a servicios de salud mental comunitarios para terapia continua. Las necesidades terapéuticas (como afrontar cambios importantes en la vida o manejar la ansiedad o la depresión severas) se abordan mejor con terapeutas de salud mental. Nuestro defensor familiar puede ayudar a acceder a los servicios de salud mental comunitarios.
 *
Required
Have you contacted the student's teacher already?
¿Ya te has puesto en contacto con el profesor del alumno?
 *
What sort of support are you wanting your student to receive? 
¿Qué tipo de apoyo desea que reciba su alumno?
Has your student received any discipline referrals this semester?
¿Ha recibido su alumno alguna amonestación disciplinaria este semestre?
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Please describe your concern below. 
Por favor, describa su inquietud a continuación.
A copy of your responses will be emailed to .
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