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Referral Form to see the Counselor
Please fill out this form if there is something that I can help you with.
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Today's Date:
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Student's Name:
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Teacher's Name
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Grade Level
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3rd Grade
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6th Grade
I need help with:
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If you marked, something else, tell me a little more about what you need help with.
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This is:
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I have GOOD NEWS to share!
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